Print Violation: CALMS - 00106059

Provider Information

The Esther at Riverbend Assisted Living

3535 E GAME FARM RD
Springfield, OR 97477

Date: 3/3/2026
Report number: CALMS - 00106059
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to follow care plan
Result: Substantiated
Rule(s) Violated: External site: 411-054-0036(2)(g)
Findings: The facility allegedly failed to follow the service plan for the Alleged Victim. There was no documented evidence that the facility completed the required hourly safety checks as outlined in the temporary service plans dated 02/26/26 and 02/28/26, following the resident’s fall with injury. The facility’s failure to ensure the implementation of required services was substantiated. The investigation determined this constitutes a violation of Oregon Administrative Rules.