Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: CALMS - 00084021
Provider Information
Pacific Grove Memory Care
3334 22ND AVE
Forest Grove, OR 97116
- Provider ID
- 5MA242
- Administrator
- Amanda Hatcher
- Phone
- (503) 359-1002
- mced@pacificgroveslc.com
Violation Details
- Date
- 7/2/2025
- Report number
- CALMS - 00084021
- Type
- Licensing Violation
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to update staffing plan based on ABST
- Result
- Substantiated
- Rule(s) Violated
-
External site: 411-054-0037(1)(a-c) and (3)
- Findings
- Based on interview and record review, conducted during a site visit on 07/10/25 and 07/11/25 the facility's failure to develop and maintain an Acuity Based Staffing Tool (ABST) was substantiated for1 of 3 sampled residents (#1). Findings include, but are not limited to: A review of the Facility ABST and the facility census indicated the facility census was 44. A review of Resident 1’s service plan, dated 07/02/25, and his/her ABST last edited on 07/02/25, indicated the following: Resident 1's service plan indicated that staff assistance with monitoring a change in behavior and time spent cueing and redirecting due to cognitive impairments was required; and There was no time in Resident 1's ABST profile for assistance with those Activities of Daily Living. In an interview on 07/10/25, Staff 1 stated Staff 6 was responsible for updating the ABST. A review of the facility posted staffing plan and staff schedule for 07/03/25 through 07/10/25 indicated the facility was staffed to the posted staffing plan. No missed needs were observed. The facility failed to accurately capture care time and care elements that staff are providing to each resident as outlined in each individual service plan. Corrective Action taken on related allegation