Print Violation: CALMS - 00088948

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 6/8/2025
Report number: CALMS - 00088948
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to address resident's behavior
Result: Substantiated
Rule(s) Violated: External site: 411-057-0160(2)(e)
Findings: Based on interview and record review, conducted during a site visit on 09/16/25, the facility’s failure to ensure behavioral symptoms that negatively impact the resident and others in the community must be evaluated and included on the service or care plan was substantiated for 1 of 1 sampled resident(s). Findings include, but are not limited to: A review of Resident 1’s Interim Service Plan, dated 06/08/25, indicated the following: Resident 1 is known to hoard food and will sometimes feed other residents. In an interview Staff 2 stated s/he was unable to locate a behavioral evaluation for Resident 1 and stated there was no behavioral assessment on file. The facility’s failure to ensure behavioral symptoms that negatively impact the resident and others in the community must be evaluated was substantiated.