Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: CALMS - 00085669
Provider Information
Countryside Living Memory Care
390 NW 2ND AVE
Canby, OR 97013
- Provider ID
- 50R283
- Administrator
- STACY ZIMMERMAN
- Phone
- (503) 266-3031
- ed@countrysidelivingcanby.com
Violation Details
- Date
- 6/10/2025
- Report number
- CALMS - 00085669
- Type
- Licensing Violation
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to use an ABST
- Result
- Substantiated
- Rule(s) Violated
-
External site: 411-054-0037(4)
- Findings
- Based on interview and record review conducted during a site visit on 06/13/25, 06/16/25, and 06/17/25, the facility’s failure to develop, maintain, and implement an Acuity-Based Staffing Tool was substantiated for 1 of 1 sampled resident (#1). Findings include but are not limited to: A review of the facility’s ABST indicated that four out of 29 residents’ ABST evaluations had not been updated at least quarterly. Two residents had not been updated since April 2024, and two residents had not been updated since November 2024. A review of the posted staffing plan dated 04/25/25 indicated the following: - Day shift: Three Caregivers and one Med Tech; - Swing shift: Three Caregivers and one Med Tech; and - NOC shift: One Caregiver and One Med Tech. A review of the facility’s staff schedule dated 06/06/25 through 06/13/25 indicated the following for the NOC shift: - One Caregiver; and - One Med Tech The facility had six residents requiring two-person transfers and was not consistently scheduled to meet the scheduled and unscheduled needs of all residents for the NOC shift. In an interview, Staff 1 stated that if there was an emergency on the NOC shift, the facility would borrow staff from the sister facility across the street. And that some staff members resided near the facility and could be there quickly if needed. Staff 1 stated they were not aware that the facility could not use staff members from another facility or community members to evacuate the building. The facility failed to develop a staffing plan for each shift that meets the scheduled and unscheduled needs of all residents, and the facility failed to update resident profiles at least quarterly. The facility failed to have an updated Acuity-Based Staffing Tool (ABST) that accurately reflected the resident population and their care needs. Inconsistencies were identified between the resident roster, care plans, and the data entered into the ABST. An investigation determined this is a violation of Oregon Administrative Rules.