Print Violation: CALMS - 00083414

Provider Information

Pacific Grove Senior Living Community

2112 OAK ST
Forest Grove, OR 97116

Date: 3/28/2025
Report number: CALMS - 00083414
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to follow care plan
Result: Substantiated
Rule(s) Violated: External site: 411-054-0036(2)(g)
Findings: Based on interview and record review, conducted during a site visit on 04/17/25, the facility’s failure to ensure the implementation of services was substantiated for 2 of 10 sampled residents (#2 and #6). Findings include, but are not limited to: In an interview on 04/17/25, Resident 2 stated, "I have waited up to one hour for a brief change." Review of Resident 2's service plan, dated 04/05/25, indicated Resident 2 required staff assistance with the following ADLs: Housekeeping Toileting, continence, bowel and bladder management Review of Resident 6's service plan, dated 01/29/25, indicated Resident 6 required assistance with the following ADLs: Housekeeping Toileting, continence, bowel and bladder management In an interview on 04/17/25, Resident 6 stated, "They have left a lot of BM (bowel movement) on me at times. I have let the administrator know," and "It has taken between 30 to 45 minutes for a brief change." The findings were reviewed with and acknowledged by Staff 1 (Administrator) and Staff 2 (LPN) on 04/17/25. The facility’s failure to ensure the implementation of services was substantiated.