Print Violation: OR0004829000

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 2/7/2024
Report number: OR0004829000
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to report potential or suspected abuse
Result: Substantiated
Rule(s) Violated: External site: 411-054-0028(2)(b)
Findings: Based on interview and record review, conducted during a site visit on 02/07/24 through 02/13/24, it was confirmed the facility failed to immediately notify the local Department office of an incident of abuse or suspected abuse for 1 of 1 sampled residents (# 29).During an interview on 02/07/24, Staff 8 stated s/he had deleted the incident report and interim service plan as s/he "didn't think it was a real incident. "S/he stated the facility had not reported the incident to the local Seniors and People with Disabilities (SPD) office. During an interview on 02/07/24, Staff 1 confirmed the facility had not reported the incident to the local SPD. It was determined the facility failed to immediately notify the local Department office or the local AAA of any incident of abuse or suspected abuse.