Print Violation: OR0004829006

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Date: 2/7/2024
Report number: OR0004829006
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)(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 ensure the preparation, completeness, accuracy, and preservation of resident records for 1 of 1 sampled resident (# 29). During an interview on 02/07/24, Staff 9 stated s/he had created an incident report and interim service plan regarding potential sexual abuse for an altercation involving Resident 29 and another resident on 01/29/24. During an interview on 02/07/24, Staff 8 stated s/he had deleted the incident and interim service plan for Resident 29 as s/he "did not think it was an incident." There was not documented evidence of an incident report or temporary service plan for Resident 29 involving the alleged incident on 01/29/24.