Provider Details

Aging and People with Disabilities

Safety, Oversight and Quality

Oregon Department of Human Services Logo

Print Violation: OR0004897901

Provider Information

Pacific Grove Memory Care

3334 22ND AVE
Forest Grove, OR 97116

Provider ID
5MA242
Administrator
Amanda Hatcher
Phone
(503) 359-1002
Email
mced@pacificgroveslc.com

Violation Details

Date
3/6/2024
Report number
OR0004897901
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to keep medication record current or accurate
Result
Substantiated
Rule(s) Violated
External site: 411-054-0055(2)
Findings
It was determined the facility failed to keep an accurate Medication Administration Record (MAR) of all medications, including over-the-counter medications that are ordered by a legally recognized prescriber for 15 of 15 sampled residents (#s 2, 3, 4, 7, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, and 19) whose MARs were reviewed. A review of Resident 2's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Cefpodoxime used to treat infection on 03/06/24. * One dose of Melatonin used to treat delayed sleep on 03/06/24. A review of Resident 3's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Trazodone used to treat insomnia on 03/06/24. * One dose of Preparation H cream used to treat rectal itching and pain on 03/06/24. * One dose of Salicylic Acid patch used to treat skin disorder on 03/06/24. * One dose of Carbidopa used to treat Parkinson ' s disease on 03/13/24. A review of Resident 4's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Depakote used to treat seizure disorder on 03/06/24. * One dose of Quetiapine used to treat Alzheimer ' s disease on 03/06/24. A review of Resident 7's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Metformin used to treat diabetes on 03/06/24. * One dose of Olanzapine used to treat agitation on 03/06/24. * One dose of Senna used to treat constipation on 03/06/24. * One dose of Trazodone used to treat insomnia on 03/06/24. * One dose of Fluoxetine used to treat depression on 03/30/24. * One dose of Lisinopril used to treat hypertension on 03/30/24. * One dose of Melatonin used to treat insomnia on 03/30/24. * One dose of Trazodone used to treat insomnia on 03/30/24. A review of Resident 9's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Atorvastatin used to treat cholesterol on 03/06/24. A review of Resident 10's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Quetiapine used to treat Alzheimer's disease on 03/06/24. * One dose of Acetaminophen used to treat osteoarthritis on 03/13/24. A review of Resident 11's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * Six doses of Refresh Optive Opthalmic Gel used to treat eye irritation on 03/06/24, 03/14/24, 03/20/24, 3/27/24, 3/28/24, and 3/30/24. * Three doses of Camphor-menthol lotion used to treat dry skin on 3/20/24, 3/27/24, and 3/28/24. * Three doses of Eucerin Cream used to treat dry skin on 3/20/24, 3/27/24, and 3/28/24. A review of Resident 12's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Clopidgrel used to treat stroke prevention on 03/06/24. * One dose of Donepezil used to treat Alzheimer ' s disease on 03/06/24. * One dose of Melatonin used to treat delayed sleep on 03/06/24. * One dose of Namenda use to treat dementia on 03/06/24. * One dose of Hydragaurd Silicone cream used to treat skin breakdown on 03/06/24. * Two doses of Clotrimazole cream used to treat chronic dermatitis on 03/27/24 and 03/28/24. A review of Resident 13's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Enulose Solution used to treat constipation on 03/06/24. A review of Resident 14's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Tamsulosin used to treat enlarged prostate on 03/06/24. A review of Resident 15's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Donepezil used to treat Alzheimer ' s disease on 03/06/24. A review of Resident 16's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * Three doses of Acetaminophen used to treat arthritis pain on 03/04/24, 03/05/24, and 03/06/24. A review of Resident 17's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Cosopt Opthamalic used to treat glaucoma on 03/06/24. * One dose of Melatonin used to treat delayed sleep on 03/06/24, 3/14/24, 3/24/24, 3/30/24. * One dose of Memantine used to treat dementia on 03/06/24. * One dose of Methylphenidate used to treat depression on 03/06/24. A review of Resident 18's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * One dose of Memantine used to treat dementia on 03/06/24. * One dose of Mirtazapine used to treat major depressive disorder on 03/06/24. * One dose of Trazodone used to treat delayed sleep on 03/06/24. * Three doses of Camphor-menthol lotion used to treat dry and itching skin on 3/26/24 and 3/27/24. A review of Resident 19's MAR, dated 03/01/24-03/31/24, indicated missing signatures for the following medications: * Six doses of skin cleanse treatment used to treat candidiasis of skin on 03/06/24, 3/20/24, 3/24/24, 03/27/24, 03/28/24, and 03/30/24.