Print Violation: CALMS - 00106058

Provider Information

The Esther at Riverbend Assisted Living

3535 E GAME FARM RD
Springfield, OR 97477

Date: 3/3/2026
Report number: CALMS - 00106058
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide oversight and monitoring of change of condition
Result: Substantiated
Rule(s) Violated: External site: 411-054-0040(2)(a)
Findings: The facility allegedly failed to provide required oversight and monitoring. There was no documented evidence that the facility completed the required hourly safety checks as specified in the temporary service plans dated 02/26/26 and 02/28/26 following the resident’s fall with injury. The facility failed to monitor the Alleged Victim in accordance with his or her evaluated needs and service plan. The investigation determined this constitutes a violation of Oregon Administrative Rules.