I have a loved one here and I'm very pleased. The staff are genuinely caring, attentive and professional - they go the extra mile and make families feel welcome. The community is bright, clean and home-like, with outstanding, varied dining, nonstop activities and great amenities (fitness, salon, theater, outings) plus on-site nursing and strong communication - overall a warm, well-run place I'd recommend.
Loved one of resident
Jul 2026
Pricing
Prices shown are estimates and subject to change. Contact your senior living advisor for current pricing.
On-site clinical oversight (RN and resident care coordinator)
Transportation services for appointments and trips
Cons
Variable management professionalism and communication
Inconsistent administrative and customer-service responsiveness
Gaps in staff training and process consistency
Billing and fee-policy transparency concerns
Post-hospice rent increases and fee adjustments
Unclear application and employment documentation practices
Limited payer acceptance (no Medicare)
Summary of reviews
Waverly Place is consistently described as a modern, well-maintained community with many physical and programmatic strengths. Reviewers highlight a recently built or renovated environment with ample natural light, spacious and accessible apartment designs (including large bathrooms, walk-in showers, and some units with in-unit washer/dryer), and a broad set of on-site amenities such as a movie theater, salon, fitness room, coffee bar, and multiple social spaces. The property layout and grounds are generally viewed as attractive and conducive to resident mobility and socialization.
Care and staffing are prominent positive themes. Many families describe staff as compassionate, attentive, and family-oriented; multiple comments cite proactive nursing involvement, on-site RN oversight, a resident care coordinator, and effective collaboration with hospice when appropriate. Memory-care offerings are noted as available and staffed, and several accounts describe measurable improvements in resident engagement, grooming, and appetite after moving in. At the same time, there is variability in accounts of staff performance: while many praise caregivers and med-techs for kindness and responsiveness, other remarks point to uneven training or process adherence in some instances.
Dining and activities are consistent strengths. The dining program receives frequent praise for quality, variety, and flavor; reviewers repeatedly call the food exceptional for an institutional setting. Programming is described as robust and diverse—exercise classes, art, bingo, movie nights, bible study, outings, and special events are regularly noted—and the community operates transportation for appointments and trips. These offerings appear to support an engaged and active resident population.
Administrative and management issues are the primary area of concern. Several reviews characterize management communication and professionalism as inconsistent: families report both positive interactions with helpful front-desk and nursing staff and frustrations with responsiveness, customer-service handling, and leadership behavior in specific circumstances. There are repeated concerns about billing and fee-policy transparency, including commentary about rent or fee adjustments tied to end-of-life transitions; these raise questions for some families about predictable costs. Additional administrative items include unclear application and employment-documentation processes and an explicit policy limitation: Medicare is not accepted for payment. These operational matters do not negate the facility’s clinical and programmatic strengths, but they are recurring considerations for prospective residents and families.
Overall, Waverly Place is presented as a high-quality, activity-rich community with strong dining and clinical touchpoints and a welcoming, family-like culture. Prospective residents should weigh those strengths against noted administrative and communication inconsistencies—asking for written fee schedules, clear explanations of payer acceptance, and examples of staff training and escalation procedures during tours and contract negotiations can help address the most commonly raised concerns.
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Location
Waverly Place is located at 2853 SE Salem Ave, Albany, OR, 97321.
About Waverly Place
Waverly Place Assisted Living is an elegant, state-of-the-art senior living community designed to provide exceptional care and comfort to its residents. The community features a thoughtfully designed environment, offering 71 spacious assisted living units and a dedicated 20-bed memory care community. This commitment to comprehensive service is further enhanced by the presence of Wellness at Home, an onsite in-home health care agency. Residents at Waverly Place benefit from the support of a highly trained, compassionate team focused on creating a real sense of community and individual well-being.
The philosophy at Waverly Place centers around empowering seniors to remain as independent as possible, while also ensuring that personalized support is always available when needed. Each resident is encouraged to make choices about their daily lives, and the staff walks beside them as supportive companions. Waverly Place truly embodies the belief that the best senior living allows each individual to experience life to its fullest, surrounded by caring professionals and a vibrant community of peers.
A hallmark of life at Waverly Place is the exceptional dining experience. Every day, a variety of delectable meals are prepared by talented chefs, promising a sensational culinary journey for residents. Mealtimes are an opportunity to gather, socialize, and enjoy the comforts of home combined with high-quality service. The dining options are complemented by signature programs that help residents retain their abilities and independence. These programs are thoughtfully designed, aiming to enhance self-esteem and promote meaningful engagement by building activities around each person’s interests, talents, and abilities.
Waverly Place recognizes the importance of fostering connections—between residents, their families, and the team—believing that together they create a unique and joyful community spirit. The activities calendar is robust and varied, with options that stimulate the mind, body, and spirit. Whether residents are enjoying a game of chess, sipping coffee with friends, or spending time with loved ones, every day presents new opportunities for fulfillment and enjoyment. The community is also proudly pet-friendly, welcoming furry companions as part of its resident family and creating even more avenues for comfort and happiness. At Waverly Place, residents and their loved ones can discover the joy, security, and vibrancy that make this community truly exceptional.
People often ask...
Waverly Place offers competitive pricing, with rates starting at a cost of $5,769 per month.
Waverly Place offers assisted living and memory care.
There are 29 photos of Waverly Place on Mirador.
The full address for this community is 2853 SE Salem Ave, Albany, OR 97321.
No, Waverly Place does not offer respite care.
Respite care in assisted living communities provides temporary, short-term relief for primary caregivers by offering professional care for their loved ones. It allows individuals to stay in an assisted living community for a limited time, giving caregivers a break while ensuring residents receive necessary support and assistance with daily activities.
Safety & Compliance
In Oregon, the Department of Human Services' Aging & People with Disabilities program licenses assisted living and residential care facilities, conducting inspections, complaint investigations, and renewals.
Investigated a complaint alleging failure to provide needed services; found that care planning and interventions were not provided, resulting in a resident's fall and discomfort, constituting abuse and neglect.
Abuse—Failed to provide service
09 Jan 2026Abuse: Neglect
09 Jan 2026Abuse: Neglect
Investigated a complaint and found neglect of care and abuse due to failure to provide appropriate services and care planning after a resident fall; a fine was assessed.
Abuse—Failed to provide service
11 Dec 2025Inspection
11 Dec 2025Inspection
Found failure to provide records upon request.
Licensing—Failed to submit timely or adequate staffing documentation
11 Dec 2025Inspection
11 Dec 2025Inspection
Investigated the allegation and determined records were not provided to the Department upon request.
Licensing—Failed to make facility or resident records accessible
11 Dec 2025Inspection
11 Dec 2025Inspection
Found that records were not provided to the department upon request.
Licensing—Failed to make facility or resident records accessible
11 Dec 2025Inspection
11 Dec 2025Inspection
Found that records were not provided upon request, indicating a staffing documentation deficiency.
Licensing—Failed to submit timely or adequate staffing documentation
07 Dec 2025Inspection
07 Dec 2025Inspection
Determined that medication was not administered as ordered and left unattended for hours, creating risk of harm and indicating neglect and abuse.
Licensing—Failed to administer medication as ordered
29 Oct 2025Abuse: Neglect
29 Oct 2025Abuse: Neglect
Investigated found failure to provide proper care planning and interventions, resulting in a fall and knee pain.
Abuse—Failed to provide service
15 Oct 2025Inspection
15 Oct 2025Inspection
Determined that the provider failed to provide a safe medication administration system, resulting in a substantiated Level 2 violation with potential for harm.
Licensing—Failed to provide a safe medication administration system
25 Sept 2025Kitchen
25 Sept 2025Kitchen
Identified deficiencies in meals and food sanitation and administration compliance, including hot holding temperatures below requirement, missing temperature logs, and sanitation issues in kitchen areas.
Investigated a report of abuse and neglect; found the provider failed to provide necessary services and implement care planning, resulting in injuries to a resident.
Abuse—Failed to provide service
06 Aug 2025Abuse: Neglect
06 Aug 2025Abuse: Neglect
Investigated a neglect allegation and determined that care planning failed to mitigate injury risk, resulting in pain and skin injuries.
Abuse—Failed to properly plan care
04 Aug 2025Abuse: Neglect
04 Aug 2025Abuse: Neglect
Investigated allegations of abuse/neglect and found failure to properly plan care, resulting in multiple falls and injuries, and a fine was assessed.
Abuse—Failed to properly plan care
31 Jul 2025Inspection
31 Jul 2025Inspection
Investigated a complaint and identified a deficiency in administering medication as ordered.
Licensing—Failed to administer medication as ordered
10 Jul 2025Abuse: Neglect
10 Jul 2025Abuse: Neglect
Investigated an allegation of neglect related to care planning and fall risk; found inadequate planning increased the risk of harm and resulted in a fine.
Abuse—Failed to properly plan care
10 Jul 2025Abuse: Neglect
10 Jul 2025Abuse: Neglect
Found neglect due to failure to properly plan care, leading to a fall with injury. A $375 fine was assessed.
Abuse—Failed to properly plan care
10 Jul 2025Abuse: Neglect
10 Jul 2025Abuse: Neglect
Investigated an allegation of neglect in care planning after a fall injury; found failure to plan care to mitigate fall risk.
Abuse—Failed to properly plan care
11 Jun 2025Inspection
11 Jun 2025Inspection
Investigated and found a deficiency for not maintaining an updated ABST that accurately reflected residents’ care needs; inconsistencies were identified between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
09 Jun 2025Complaint
09 Jun 2025Complaint
Investigated and found that the Acuity-Based Staffing Tool was not fully implemented or updated, resulting in a quarterly evaluation gap for a resident.
Deficiency—Acuity Based Staffing Tool - Updates & Plan
05 Jun 2025Inspection
05 Jun 2025Inspection
Found a deficiency for failing to develop, maintain, and implement an Acuity Based Staffing Tool.
Licensing—Failed to provide safe environment
01 Jun 2025Inspection
01 Jun 2025Inspection
Investigated and found that an updated ABST was not maintained to reflect resident needs, with inconsistencies among the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
29 May 2025Inspection
29 May 2025Inspection
Identified inconsistencies between the resident roster, care plans, and ABST data, and found the ABST not updated to reflect resident needs.
Licensing—Failed to use an ABST
29 May 2025Inspection
29 May 2025Inspection
Found deficiencies in the Acuity-Based Staffing Tool that did not reflect the resident population and care needs, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
28 May 2025Inspection
28 May 2025Inspection
Found a deficiency in ABST accuracy, tied to an allegation that ABST did not reflect the resident population and care needs, with inconsistencies among the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
27 May 2025Inspection
27 May 2025Inspection
Found deficiencies in updating the ABST and inconsistencies between the resident roster, care plans, and ABST data.
Licensing—Failed to use an ABST
26 May 2025Inspection
26 May 2025Inspection
Investigated identified a deficiency where the Acuity-Based Staffing Tool was not updated to reflect residents' needs, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
25 May 2025Inspection
25 May 2025Inspection
Identified a deficiency where the Acuity-Based Staffing Tool did not accurately reflect resident care needs, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
24 May 2025Inspection
24 May 2025Inspection
Found failure to administer medication as ordered. This constitutes a violation of Oregon Administrative Rules.
Licensing—Failed to administer medication as ordered
24 May 2025Inspection
24 May 2025Inspection
Found a deficiency where an acuity-based staffing tool was not updated to reflect resident needs, causing inconsistencies with the roster and care plans.
Licensing—Failed to use an ABST
12 May 2025Abuse: Neglect
12 May 2025Abuse: Neglect
Investigated a medication management failure that delayed antibiotics for a resident, leading to infection progression and hospital care.
Abuse—Failed to provide a safe medication administration system
26 Apr 2025Abuse: Neglect
26 Apr 2025Abuse: Neglect
Investigated a complaint alleging neglect. Found failure to plan care to mitigate fall risks led to an unwitnessed fall and head injury.
Abuse—Failed to properly plan care
17 Apr 2025Inspection
17 Apr 2025Inspection
Found that the ABST was not updated to reflect resident needs, causing inconsistencies with roster and care plans.
Licensing—Failed to use an ABST
16 Apr 2025Abuse: Neglect
16 Apr 2025Abuse: Neglect
Identified neglect and abuse due to failure to provide appropriate care and follow the care plan, which led to a fall and shoulder pain.
Abuse—Failed to provide service
13 Apr 2025Abuse: Neglect
13 Apr 2025Abuse: Neglect
Investigated a transfer incident where a gait belt was not used, causing a skin injury, and found a failure to provide a safe environment.
Abuse—Failed to provide safe environment
13 Apr 2025Inspection
13 Apr 2025Inspection
Investigated and identified deficiencies in the Acuity-Based Staffing Tool, with inconsistencies between the resident roster, care plans, and ABST data that failed to reflect care needs.
Licensing—Failed to use an ABST
13 Apr 2025Inspection
13 Apr 2025Inspection
Found a violation for not following a mobility care plan during a transfer, which caused a skin injury.
Licensing—Failed to follow care plan
08 Apr 2025Inspection
08 Apr 2025Inspection
Found a deficiency in maintaining an updated ABST that accurately reflected the resident population and care needs, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
07 Apr 2025Inspection
07 Apr 2025Inspection
Determined a violation due to an outdated ABST not reflecting resident needs, with inconsistencies between roster, care plans, and ABST data.
Licensing—Failed to use an ABST
03 Apr 2025License Condition
03 Apr 2025License Condition
Investigated and found a failure to provide a safe environment.
Regulatory Action—Failed to provide safe environment
01 Apr 2025Abuse: Neglect
01 Apr 2025Abuse: Neglect
Investigated a fall-related care issue and found failures to plan care and implement fall-prevention measures, resulting in a resident injury and a $500 fine.
Abuse—Failed to properly plan care
31 Mar 2025Inspection
31 Mar 2025Inspection
Investigated a staffing allegation and found the Acuity-Based Staffing Tool was not updated to reflect resident needs, with inconsistencies among the roster, care plans, and ABST data.
Licensing—Failed to staff as indicated by ABST
29 Mar 2025Inspection
29 Mar 2025Inspection
Found inconsistencies between the resident roster, care plans, and ABST data, and identified the failure to maintain an updated ABST reflecting resident care needs.
Licensing—Failed to use an ABST
29 Mar 2025Abuse: Neglect
29 Mar 2025Abuse: Neglect
Investigated and found improper care planning for a resident with an injured knee, which contributed to a fall and a fractured ankle.
Abuse—Failed to properly plan care
23 Mar 2025Abuse: Neglect
23 Mar 2025Abuse: Neglect
Investigation found failures to properly plan care for a resident's repeated falls, with multiple falls occurring and no documented updates to interventions. A fine was assessed.
Abuse—Failed to properly plan care
23 Mar 2025Inspection
23 Mar 2025Inspection
Investigated and found a deficiency related to an updated ABST that did not reflect resident care needs, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
20 Mar 2025Licensure
20 Mar 2025Licensure
Observed pervasive governance and care deficiencies with unsafe practices, including poor quality improvement, abuse reporting failures, incomplete resident evaluations and plans, and inadequate monitoring of changes in condition, along with nursing, medication, staffing, and safety shortfalls.
Deficiency—Resident Move-in & Evaluation: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Service Plan: Service Planning Team
Deficiency—Service Plan: Managed Risk
Deficiency—Change of Condition and Monitoring
Deficiency—Resident Health Services
Deficiency—Systems: Treatment Orders
Deficiency—Systems: Resident Right to Refuse
Deficiency—Systems: Medication Administration
Deficiency—Systems: Self-Administration of Meds
Deficiency—Acuity Based Staffing Tool - ABST Time
Deficiency—Acuity Based Staffing Tool - Updates & Staffing Plan
Deficiency—Training Within 30 Days of Hire – Direct Care Staff
Deficiency—Annual and Biennial Inservice for All Staff
Deficiency—Fire and Life Safety: Safety
Deficiency—Fire and Life Safety: Training for Residents
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Plumbing Systems
15 Mar 2025Inspection
15 Mar 2025Inspection
Found inconsistencies between the resident roster, care plans, and the Acuity-Based Staffing Tool, indicating the ABST was not updated to reflect resident needs.
Licensing—Failed to use an ABST
15 Mar 2025Abuse: Neglect
15 Mar 2025Abuse: Neglect
Investigated and found neglect of care due to failure to implement interventions to reduce fall-related injury risk.
Abuse—Failed to properly plan care
15 Mar 2025Abuse: Neglect
15 Mar 2025Abuse: Neglect
Investigated determined neglect occurred due to failure to properly plan care, resulting in a fall with injuries. A $500 fine was assessed.
Abuse—Failed to properly plan care
14 Mar 2025License Condition
14 Mar 2025License Condition
Found deficiencies related to providing a safe environment.
Regulatory Action—Failed to provide safe environment
11 Mar 2025Inspection
11 Mar 2025Inspection
Identified inconsistencies in the ABST reflecting resident needs and ADLs, and insufficient staffing relative to ABST indications.
Licensing—Failed to use an ABST
11 Mar 2025Abuse: Neglect
11 Mar 2025Abuse: Neglect
Found deficiencies in care planning for a resident with a falls history, resulting in four falls with injuries and no documented fall-prevention interventions. A $375 fine was assessed.
Abuse—Failed to properly plan care
05 Mar 2025Inspection
05 Mar 2025Inspection
Investigated a complaint alleging failure to report abuse; found that the administrator or designee did not immediately notify the local Department or local AAA and did not report a resident's bruising and injuries to APS.
Licensing—Failed to provide safe environment
05 Mar 2025Inspection
05 Mar 2025Inspection
Identified a deficiency where the Acuity-Based Staffing Tool did not reflect resident care needs. Inconsistencies between the roster, care plans, and ABST data were found.
Licensing—Failed to use an ABST
05 Mar 2025Inspection
05 Mar 2025Inspection
Found failure to properly plan care after a resident returned with a broken leg due to the resident's service plans not being updated.
Licensing—Failed to properly plan care
03 Mar 2025Licensure
03 Mar 2025Licensure
Determined multiple deficiencies across administration, resident services, health care, medications, safety, and facility operations, with widespread violations found during the review.
Deficiency—Resident Move-in & Evaluation: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Change of Condition and Monitoring
Deficiency—Resident Health Services
Deficiency—Res Hlth Srvc: On- and Off-Site Health Srvc
Deficiency—Systems: Medications and Treatments
Deficiency—Systems: Tracking Control Substances
Deficiency—Systems: Treatment Orders
Deficiency—Systems: Medication Administration
Deficiency—Systems: Psychotropic Medication
Deficiency—Restraints and Supportive Devices
Deficiency—Acuity Based Staffing Tool - ABST Time
Deficiency—Acuity Based Staffing Tool - Updates & Staffing Plan
Deficiency—Training Within 30 Days of Hire – Direct Care Staff
Deficiency—Fire and Life Safety: Safety
Deficiency—Fire and Life Safety: Training for Residents
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—General Building Exterior
Deficiency—Doors, Walls, Elevators, Odors
Deficiency—Individual Rights Settings: Privacy, Dignity
Deficiency—Individual Privacy: Own Unit
Deficiency—Individual Door Locks: Key Access
Deficiency—Resident Move-in & Evaluation: Res Evaluation
Deficiency—Administration Compliance
Deficiency—Staff Training Requirements
Deficiency—Compliance with Rules Health Care
Deficiency—Nutrition and Hydration
Deficiency—Activities
03 Mar 2025Inspection
03 Mar 2025Inspection
Investigated and found that an acuity-based staffing tool was not developed, maintained, or implemented according to the rule.
Licensing—Failed to provide safe environment
03 Mar 2025Abuse: Neglect
03 Mar 2025Abuse: Neglect
Investigated found that staff failed to provide a safe environment and proper gait belt training, resulting in a skin injury during transfers.
Abuse—Failed to provide safe environment
11 Feb 2025Abuse: Neglect
11 Feb 2025Abuse: Neglect
Found neglect and abuse due to failure to provide ordered medical treatment, resulting in a $500 fine.
Abuse—Failed to provide medical treatment as ordered
25 Jan 2025Abuse: Neglect
25 Jan 2025Abuse: Neglect
Investigated a resident care concern and found neglect and abuse due to failure to properly plan care after an unwitnessed fall.
Abuse—Failed to properly plan care
25 Nov 2024Inspection
25 Nov 2024Inspection
Identified deficiencies in the Acuity-Based Staffing Tool accuracy and data consistency. The investigation concluded these issues violated Oregon Administrative Rules.
Licensing—Failed to use an ABST
21 Nov 2024Abuse: Neglect
21 Nov 2024Abuse: Neglect
Investigated the complaint and found a failure to properly plan fall interventions after known fall history, indicating neglect and abuse.
Abuse—Failed to properly plan care
21 Nov 2024Abuse: Neglect
21 Nov 2024Abuse: Neglect
Investigated the allegation of neglect and found the facility failed to update care plans with fall prevention interventions after a known fall.
Abuse—Failed to properly plan care
10 Nov 2024Abuse: Neglect
10 Nov 2024Abuse: Neglect
Investigated a fall-related complaint and found failures in care planning for fall risk. These failures contributed to a fractured hip and a significant change in condition.
Abuse—Failed to properly plan care
10 Nov 2024Inspection
10 Nov 2024Inspection
Identified deficiencies in ABST accuracy and related staffing levels, with inconsistencies between the resident roster, care plans, and ABST data.
Licensing—Failed to use an ABST
05 Nov 2024Inspection
05 Nov 2024Inspection
Identified deficiencies in the Acuity-Based Staffing Tool that did not reflect resident needs or required ADLs, with inconsistencies between the roster, care plans, and ABST data. Staffing did not meet the levels indicated by the ABST to cover scheduled and unscheduled resident needs.
Licensing—Failed to use an ABST
04 Nov 2024Inspection
04 Nov 2024Inspection
Determined that proper meals and snacks were not provided seven days a week.
Licensing—Failed to provide proper food/nutrition
01 Nov 2024Inspection
01 Nov 2024Inspection
Identified deficiencies in the Acuity-Based Staffing Tool that did not accurately reflect resident needs or ADLs, with inconsistencies among the roster, care plans, and ABST data, and insufficient staffing to meet needs.
Licensing—Failed to use an ABST
06 May 2024Inspection
06 May 2024Inspection
Investigated a complaint and found that a staff member failed to protect a resident from financial exploitation, with about $2,508 withdrawn from the resident's bank account between November 2023 and March 2024.
Licensing—Failed to protect resident from financial exploitation
21 Apr 2024Abuse: Neglect
21 Apr 2024Abuse: Neglect
Found that staff did not follow the service plan, resulting in neglect and abuse, and a $188 fine was assessed.
Abuse—Failed to follow care plan
22 Aug 2023Licensure
22 Aug 2023Licensure
Observed sanitation and food-handling deficiencies in the kitchen, including debris, uncovered surfaces and items, and improper handling; a later revisit found substantial compliance with food sanitation rules.
Identified sanitation and administration deficiencies in the kitchen and related areas, including temperature control issues and unclean conditions; a follow-up visit showed substantial compliance.
Investigated the allegation that an Acuity Based Staffing Tool was not used and found the ABST was not used.
Regulatory Action—Failed to use an ABST
04 Aug 2023License Condition
04 Aug 2023License Condition
Found insufficient awake direct care staff to meet residents' 24-hour needs, causing delays in assistance.
Regulatory Action—Failed to meet the scheduled and unscheduled needs of residents
12 May 2023Inspection
12 May 2023Inspection
Investigated and found that an acuity-based staffing tool was not fully implemented or updated as required.
Licensing—Failed to provide safe environment
27 Apr 2023Complaint
27 Apr 2023Complaint
Investigated a complaint and identified deficiencies related to staffing requirements and acuity-based staffing.
Deficiency—Licensing Complaint Investigation
Deficiency—Staffing Requirements and Training: Staffing
Deficiency—Acuity-Based Staffing Tool
10 Feb 2023License Condition
10 Feb 2023License Condition
Found staffing insufficient to meet residents' scheduled and unscheduled needs, causing delays in showers and long waits for call lights.
Regulatory Action—Failed to provide appropriate staffing
10 Feb 2023License Condition
10 Feb 2023License Condition
Found that medical and other records were not kept confidential, creating an unsafe environment.
Regulatory Action—Failed to provide safe environment
10 Feb 2023License Condition
10 Feb 2023License Condition
Found failure to fully implement and update an acuity-based staffing tool as required by regulation.
Regulatory Action—Failed to staff as indicated by ABST
10 Feb 2023License Condition
10 Feb 2023License Condition
Investigated and found a deficient safe environment due to a non-working dishwasher, a broken disposal, and water on the kitchen floor not cleaned.
Regulatory Action—Failed to provide safe environment
05 Dec 2022Inspection
05 Dec 2022Inspection
Investigated a staffing allegation and found insufficient direct care staff and unaddressed call lights.
Licensing—Failed to provide appropriate staffing
01 Dec 2022Complaint
01 Dec 2022Complaint
Identified deficiencies in confidentiality of resident records, staffing adequacy, use of an acuity-based staffing tool, and building cleanliness and repairs.
Deficiency—Licensing Complaint Investigation
Deficiency—Resident Rights and Protection - General
Deficiency—Staffing Requirements and Training: Staffing
Investigated a known fall risk case and found neglect and abuse due to failure to properly plan care to mitigate falls after a resident suffered injuries. A $500 fine was assessed.
Abuse—Failed to properly plan care
04 Oct 2021Validation
04 Oct 2021Validation
Identified multiple deficiencies across resident rights, health services, nutrition, activities, safety, and administration, indicating noncompliance with state rules.
Deficiency—Comment
Deficiency—Resident Rights and Protection - General
Deficiency—Resident Move-In and Eval: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Change of Condition and Monitoring
Deficiency—Resident Health Services
Deficiency—Rn Delegation and Teaching
Deficiency—Res Hlth Srvc: On- and Off-Site Health Srvc
Deficiency—Systems: Tracking Control Substances
Deficiency—Systems: Treatment Orders
Deficiency—Systems: Resident Right to Refuse
Deficiency—Systems: Medication Administration
Deficiency—Systems: Psychotropic Medication
Deficiency—Fire and Life Safety: Safety
Deficiency—Fire and Life Safety: Training For Residents
Deficiency—Administration Compliance
Deficiency—Staff Training Requirements
Deficiency—Compliance With Rules Health Care
Deficiency—Nutrition and Hydration
Deficiency—Activities
Deficiency—Behavior
04 Oct 2021Validation
04 Oct 2021Validation
Identified multiple deficiencies across move-in evaluations, care planning, monitoring of changes in condition, health services, medication administration, staff training, and fire safety. These findings showed failures to ensure accurate assessments, clear plans, proper delegation, and adequate safety training.
Deficiency—Comment
Deficiency—Resident Move-In and Eval: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Change of Condition and Monitoring
Deficiency—Resident Health Services
Deficiency—Rn Delegation and Teaching
Deficiency—Systems: Tracking Control Substances
Deficiency—Systems: Treatment Orders
Deficiency—Systems: Medication Administration
Deficiency—Systems: Psychotropic Medication
Deficiency—Staffing Requirements and Training – Pre-Serv
Deficiency—Annual and Biennial Inservice For All Staff
Deficiency—Fire and Life Safety: Safety
Deficiency—Fire and Life Safety: Training For Residents
24 Sept 2021Abuse: Neglect
24 Sept 2021Abuse: Neglect
Investigated found catheter care not provided properly, causing urine backup and infection risk; a $750 fine was assessed.
Abuse—Failed to provide service
03 Sept 2021Abuse: Neglect
03 Sept 2021Abuse: Neglect
Identified deficiencies due to inadequate interventions for falls, with 12 documented falls over two months, constituting neglect and abuse.
Abuse—Failed to properly plan care
30 Jul 2021Abuse: Neglect
30 Jul 2021Abuse: Neglect
Identified neglect and abuse due to failure to properly plan a resident's fall risk, resulting in multiple falls and delayed interventions. The finding confirmed harm from unsafe care planning.
Abuse—Failed to provide safe environment
08 Jun 2021Abuse: Neglect
08 Jun 2021Abuse: Neglect
Found violations related to catheter care that constituted abuse and neglect and assessed a $500 fine.
Abuse—Failed to follow care plan
18 Apr 2021Abuse: Neglect
18 Apr 2021Abuse: Neglect
Identified deficiencies in medication security and theft prevention after missing narcotics from an overflow cart, indicating risk for misuse of controlled medications.
Abuse—Failure to provide a system that prevents theft or misuse of medication
08 Mar 2021Inspection
08 Mar 2021Inspection
Investigated a medication administration incident and found a failure to provide a safe medication administration system, leading to improper administration.
Licensing—Failed to provide a safe medication administration system
10 Oct 2020Inspection
10 Oct 2020Inspection
Found a violation where a resident was not protected from financial exploitation, with two checks cashed for about $500 each by an individual connected to care.
Licensing—Failed to protect resident from financial exploitation
03 Nov 2019Abuse: Neglect
03 Nov 2019Abuse: Neglect
Found violations of resident rights due to staff changing a resident's clothing in a common area, causing loss of dignity; a $250 fine was assessed.
Abuse—Failed to assure resident rights
27 Apr 2019Abuse: Neglect
27 Apr 2019Abuse: Neglect
Found neglect by a staff member that caused emotional harm to a resident. A $375 fine was assessed.
Abuse—Failed to provide safe environment
16 Mar 2019Abuse: Neglect
16 Mar 2019Abuse: Neglect
Found a neglect of safety that resulted in physical harm and a $188 fine was assessed.
Abuse—Failed to provide safe environment
20 Dec 2018Abuse: Neglect
20 Dec 2018Abuse: Neglect
Investigated a neglect allegation and found a safety lapse that risked serious harm to a resident. A $375 fine was assessed.
Abuse—Failed to follow care plan
11 Jul 2018Inspection
11 Jul 2018Inspection
Found that a safe environment requirement was not met when an individual eloped from a locked setting, creating risk of serious harm.
Licensing—Failed to provide safe environment
28 Apr 2018Inspection
28 Apr 2018Inspection
Determined there was a substantiated deficiency for failing to provide a secure environment.
Licensing—Failed to provide safe environment
18 Jan 2018Inspection
18 Jan 2018Inspection
Identified failure to follow the care plan with potential for minor harm.
Licensing—Failed to follow care plan
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