Print Violation: OR0004829004

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 2/7/2024
Report number: OR0004829004
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to assure resident rights
Result: Substantiated
Rule(s) Violated: External site: 411-054-0025(8)(a)
Findings: Based on observation, interview and record review, conducted during a site visit on 02/07/24 through 02/13/24, it was confirmed the facility failed to implement a written policy that prohibits the falsification of records. A record review of a fire drill checklist dated 02/08/24 indicated a fire drill took place at 2:20 pm in the memory care. The following information was documented on the Fire Drill checklist: - The report indicated the number of participants evacuating was 55; - The escape route used was "courtyard;" and - There were 11 staff members listed on the drill as participants and at least one of those staff members was an employee of the Assisted Living Facility. No residents or staff were observed evacuating the facility. During an interview on 02/08/24, after the fire drill had been completed, Staff 1 stated "I don't know why he wrote that, no one evacuated." It was determined the facility failed to implement a written policy that prohibits the falsification of records and falsified a document regarding a fire drill.