Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: CALMS - 00085671
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 - 00085671
- Type
- Licensing Violation
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to provide safe environment
- Result
- Substantiated
- Rule(s) Violated
-
External site: 411-054-0025(4)
- Findings
- Based on observation, 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 exercise reasonable precautions against any situation that could affect the health and safety of residents was substantiated for 1 of 1 sampled resident (#1). Findings include, but are not limited to: The following documents were reviewed: - Move-in evaluation dated 12/10/24; - Progress notes dated 12/11/24 through 01/31/25; and - Service Plans dated 01/21/25 and 06/05/25. a. The resident moved into the facility on 12/11/24. The resident’s move-in evaluation, dated 12/10/24, did not identify any previous self-injurious behavior or suicidal ideations. In an interview on 06/17/25, Staff 1 stated that during the move-in evaluation meeting with the resident’s family, no previous suicidal ideation or behaviors were disclosed. Staff 1 stated the facility was made aware that the resident had a history of suicidal ideation and behaviors only after s/he exhibited these behaviors. A progress note dated 12/19/24 indicated the resident stated to a care staff that s/he would take apart a picture with a string and use the string to hang him/herself, or that s/he would stick his/her head in the toilet to drown. A progress note dated 12/20/24 indicated the resident was seen coming out of the bathroom with blood on his/her arm. The resident reported s/he had scratched him/herself and stated s/he wanted to kill himself/herself. A progress note dated 01/14/25 indicated that the resident expressed suicidal thoughts and wandered around the facility asking care staff and other residents if they had a knife s/he could use. The resident told a care staff s/he intended to cut him/herself. b. On 06/13/25, it was observed the facility had not removed or placed the pull cords for the blinds out of sight or reach of the residents in all resident rooms. Following direction by the Department that the pull cords for the blinds needed to be out of reach of the residents to ensure resident safety, the facility taped the pull cords out of the sight of the residents. On 06/16/25, it was observed the facility had cut the pull cords that allowed the blinds to go up and down and shortened the pull cords that allow the individual blind slats to tilt open and closed. In interviews on 06/16/25 and 06/17/25 respectively, Staff 1 and Staff 7 stated all pull cords were no longer accessible to residents. It was determined the facility did not exercise reasonable precautions against any condition that may threaten the health, safety, or welfare of residents. Once the facility discovered the resident had a history of suicidal ideation behavior, the facility did not ask the family for more historical details that could have been added to the service plan and used to ensure risks were removed from the unit to keep the resident safe. Additionally, following the incident the facility did not take immediate action to ensure that residents could no longer access the pull cords to the blinds. The facility failed to exercise reasonable precautions against any situation which could affect the health and safety of residents which is a violation of Oregon Administrative Rules.