I live here and am very pleased - the attentive, dedicated staff (Sarah especially) made me feel at home and safe with 24-hour trained staff and modern safety systems. My apartment is spacious and well-maintained with ocean views, courtyard and walking areas; meals are fresh and affordable in a friendly dining room, and there are plenty of activities, outings and on-site amenities (beauty/barber, pet-friendly). It's a clean, caring, vibrant community with great communication and helpful staff - a wonderful place to live.
Current/former resident
Jul 2026
Pricing
Prices shown are estimates and subject to change. Contact your senior living advisor for current pricing.
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Amenities
Healthcare services
Activities of daily living assistance
Assistance with bathing
Assistance with dressing
Assistance with transfers
Medication management
Mental wellness program
Healthcare staffing
12-16 hour nursing
24-hour call system
24-hour supervision
Meals and dining
Diabetes diet
Meal preparation and service
Restaurant-style dining
Special dietary restrictions
Room
Air-conditioning
Cable
Fully furnished
Housekeeping and linen services
Kitchenettes
Private bathrooms
Telephone
Wifi
Memory care community services
Mild cognitive impairment
Specialized memory care programming
Transportation
Community operated transportation
Transportation arrangement
Transportation arrangement (non-medical)
Common areas
Beauty salon
Computer center
Dining room
Fitness room
Gaming room
Garden
Outdoor space
Small library
Wellness center
Community services
Concierge services
Fitness programs
Move-in coordination
Activities
Community-sponsored activities
Planned day trips
Resident-run activities
Scheduled daily activities
Reviews
3.62·(13)
Overall rating
5
4
3
2
1
Care
3.7
Staff
3.8
Meals
3.3
Amenities
3.8
Value
3.6
Pros
Attentive and dedicated staff
Home-like, family atmosphere
Spacious, well-maintained apartments
Fresh, high-quality meals with communal dining
Engaging activities and family-oriented events
On-site amenities (beauty/barber shop, courtyard)
Ocean views and accessible walking areas
Secure environment with 24-hour trained staff and safety systems
Pet-friendly policy
Good communication and resident guidance
Affordable meal options
Cons
Inconsistent staff responsiveness and resident engagement
Variability in care quality and assistance consistency
Intermittent dining service continuity and kitchen staffing gaps
Gaps in facility maintenance and timely repairs
Occasional shortages of basic supplies
Limited transparency around staff scheduling and coverage
Summary of reviews
Overall impression: Shore Pines Senior Living Community is described as a comfortable, family-oriented community with strengths in physical environment, social programming, and moments of strong staff dedication. Reviews highlight spacious, well-kept apartments, attractive outdoor spaces including ocean views and walking areas, and convenient on-site amenities such as a beauty/barber shop and courtyard. The community is positioned as pet-friendly and family-accessible, with events geared toward residents and visitors.
Care and staff: Many comments emphasize committed, attentive employees and specific staff members who provide helpful guidance and effective communication. The presence of 24-hour trained staff and layered safety systems contributes to a sense of security for residents. At the same time, there are recurring indicators of inconsistency in responsiveness and engagement across shifts: some accounts describe limited interaction with staff or concerns about staff not completing tasks correctly. These patterns point to variable day-to-day execution rather than a uniform staffing model; prospective families may wish to inquire about staffing ratios, training, and supervision practices during a visit.
Dining: Dining is generally portrayed positively when staffed and operating normally—fresh, high-quality meals and communal dining opportunities are frequently cited as strengths, along with affordable meal options. However, there are indications of intermittent service continuity related to kitchen staffing and supply management (examples include a report of an absent cook and occasional shortages). These suggest operational vulnerability in meal-service continuity that could affect daily routine at times.
Activities and community life: The community offers a range of activities and family-friendly events (holiday programs, seasonal celebrations, outings) that foster social engagement and intergenerational visiting. Residents and families note both organized programming and casual social opportunities in dining areas and outdoor spaces, supporting an active, vibrant community culture.
Facilities and maintenance: Physical facilities are viewed positively for cleanliness, maintenance, and layout, including generous apartments and accessible grounds. Conversely, isolated maintenance issues (for example, delayed repairs) and occasional supply shortages have been mentioned, indicating opportunities to improve responsiveness for facility upkeep and daily provisioning.
Management and patterns to monitor: Management is described by many as approachable and family-oriented, and there are examples of staff assisting families with practical needs like locating local medical providers. Nevertheless, the combination of highly favorable accounts and a smaller number of critical ones points to variability in operational consistency. Key areas to probe further during a tour or meeting with leadership include staffing coverage and training, processes for ensuring meal-service continuity, maintenance response times, and mechanisms for monitoring and correcting lapses in care or service.
Recommendation: Shore Pines presents many attributes attractive to prospective residents—comfortable apartments, robust social programming, safety systems, and visible staff dedication. Prospective residents and families should validate operational consistency by asking for staffing schedules, sample activity calendars, meal-service plans, and examples of maintenance response protocols to confirm that the community’s positive characteristics are reliably delivered on a day-to-day basis.
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Location
Shore Pines Senior Living Community is located at 93975 Ocean Way, Gold Beach, OR, 97444.
About Shore Pines Senior Living Community
Shore Pines Senior Living Community gives older adults a comfortable setting where they can feel at home, and everything's designed to help folks stay as independent and healthy as possible, but there's always someone ready to help with bathing, dressing, or managing medication when needed, and the staff takes care to treat everyone with respect. The place sits on scenic, open grounds, with large common spaces like a TV lounge with a fireplace, a beauty salon, raised garden beds, a garden patio, and a library for quiet reading, plus residents can use free Wi-Fi, play the piano, or join activities in the fitness room or game room. Folks living here have plenty of opportunities for socializing, as there's always something going on-from movie nights and music programs to resident-run activities and group outings, and the staff works to create a community where friendships form easily.
Shore Pines also has special care programs, like memory care areas for people living with Alzheimer's or other dementias, where staff help each resident keep dignity, encourage independence, and plan activities that keep the mind active, and there's also hospice care, where folks can get comfort and good care at the end of life while hospice providers work with the staff to make sure things go as smoothly as possible. For families or friends who care for a loved one at home, respite care lets them take a short break or go on vacation while the staff steps in with flexible stays, sometimes for just a week or up to a few months, and the team also helps seniors recovering from injury or surgery.
Assisted living here lets people hold onto their independence but get help with daily things, and the staff provides 12-16 hour nursing, a 24-hour call system, round-the-clock supervision, and even helps with groceries, laundry, cleaning, guest meals, and transportation to appointments, and there's plenty of free parking and wheelchair accessible showers. The whole community's set up to be welcoming and familiar, and the focus stays on creating comfort and safety while building a strong sense of joy and togetherness, so people feel like they belong and have somewhere to call home as they age.
People often ask...
Shore Pines Senior Living Community offers competitive pricing, with rates starting at a cost of $3,395 per month.
Shore Pines Senior Living Community offers assisted living and memory care.
There are 16 photos of Shore Pines Senior Living Community on Mirador.
The full address for this community is 93975 Ocean Way, Gold Beach, OR 97444.
No, Shore Pines Senior Living Community 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.
Found that the administrator failed to assure resident rights and oversee the overall operation, quality of service, supervision, and conduct.
Licensing—Failed to assure resident rights
05 May 2026Inspection
05 May 2026Inspection
Identified that resident service plans were not updated to reflect changes in residents' conditions.
Licensing—Failed to properly plan care
05 May 2026Inspection
05 May 2026Inspection
Investigated the allegation that residents' rights to a safe and homelike environment were not assured and found a rule violation.
Licensing—Failed to assure resident rights
05 May 2026Inspection
05 May 2026Inspection
Investigated and found deficiencies in infection prevention controls that could affect safety.
Licensing—Failed to control pests
18 Mar 2026Inspection
18 Mar 2026Inspection
Found failure to immediately notify the local Department office or local AAA about abuse and to promptly investigate all reports of abuse.
Licensing—Failed to report potential or suspected abuse
18 Mar 2026Inspection
18 Mar 2026Inspection
Found failure to provide timely medical treatment and to have 24-hour systems with written policies and procedures for medical emergency response on all shifts.
Licensing—Failed to assure timely medical treatment
20 Feb 2026Abuse: Neglect
20 Feb 2026Abuse: Neglect
Investigated an allegation of neglect for failing to intervene when a resident's condition changed, finding significant weight loss with no documented interventions or provider notification, and assessed a $500 fine.
Abuse—Failed to intervene when resident's condition changed
01 Oct 2025Inspection
01 Oct 2025Inspection
Found that ABST evaluations were not completed or updated quarterly for each resident, violating ABST requirements.
Licensing—Failed to use an ABST
03 Sept 2025Abuse: Neglect
03 Sept 2025Abuse: Neglect
Investigated a fall-risk care failure and found neglect and abuse due to not planning or implementing interventions after a fall.
Abuse—Failed to properly plan care
29 Aug 2025Inspection
29 Aug 2025Inspection
Investigated an ABST-related allegation and found that Acuity-Based Staffing Tool evaluations were not completed, updated, or reviewed quarterly for each resident as required.
Licensing—Failed to use an ABST
16 Jul 2025Inspection
16 Jul 2025Inspection
Investigated the allegation found that medication and treatment orders were not carried out as prescribed for five residents, and service plans did not reflect current needs, creating immediate risk.
Licensing—Failed to provide a therapeutic diet
15 Jul 2025License Condition
15 Jul 2025License Condition
Found that a safe environment was not provided for residents.
Regulatory Action—Failed to provide safe environment
12 Jun 2025Abuse: Neglect
12 Jun 2025Abuse: Neglect
Found violations of therapeutic diet management and care plan implementation after a meal was served without monitoring, resulting in choking and hospital transport. A physician-ordered therapeutic diet was not followed.
Abuse—Failed to provide a therapeutic diet
12 Jun 2025Inspection
12 Jun 2025Inspection
Determined that prescribed altered diets were not provided for five residents, as service plans did not reflect or follow physician orders, creating immediate jeopardy.
Licensing—Failed to follow care plan
12 Jun 2025Inspection
12 Jun 2025Inspection
Determined that a training program to determine direct care staff competency was missing.
Licensing—Failed to assure a qualified caregiver was present
08 Feb 2025Inspection
08 Feb 2025Inspection
Found a failure to immediately notify the local Department of any incident of abuse or suspected abuse.
Licensing—Failed to report potential or suspected abuse
22 Jan 2025Abuse: Neglect
22 Jan 2025Abuse: Neglect
Found that a resident was not allowed to participate in routine activities and social events, causing emotional harm and violating resident rights.
Abuse—Failed to provide appropriate activities
21 Jan 2025Abuse: Neglect
21 Jan 2025Abuse: Neglect
Identified neglect and abuse due to failure to administer medications as ordered, placing the resident at risk; a $500 fine was assessed.
Abuse—Failed to administer medication as ordered
21 Jan 2025Abuse: Neglect
21 Jan 2025Abuse: Neglect
Investigated and found that a resident did not receive medications as ordered, constituting neglect and abuse. A $500 fine was assessed.
Abuse—Failed to administer medication as ordered
16 Jan 2025Inspection
16 Jan 2025Inspection
Identified deficiencies in the Acuity-Based Staffing Tool and inconsistencies between resident rosters, care plans, and ABST data that affected staffing levels.
Licensing—Failed to use an ABST
16 Jan 2025Inspection
16 Jan 2025Inspection
Found deficiencies in the Acuity-Based Staffing Tool accuracy and related staffing levels, with inconsistencies between rosters, care plans, and ABST data.
Licensing—Failed to use an ABST
09 Jan 2025Abuse: Neglect
09 Jan 2025Abuse: Neglect
Investigated a complaint about safety and care; found a resident did not have a safe environment because a peer's verbal abuse was not addressed in the care plan, resulting in neglect and abuse.
Abuse—Failed to provide safe environment
20 Nov 2024Inspection
20 Nov 2024Inspection
Investigated the allegation and identified deficiencies in updating the Acuity-Based Staffing Tool, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
20 Nov 2024Inspection
20 Nov 2024Inspection
Investigated and determined insufficient staff to meet residents' scheduled and unscheduled needs, leading to unmet needs and delays in care.
Licensing—Failed to meet the scheduled and unscheduled needs of residents
11 Nov 2024Inspection
11 Nov 2024Inspection
Found that medication and treatment orders were not carried out as prescribed for sampled residents.
Licensing—Failed to provide a safe medication administration system
23 Sept 2024Inspection
23 Sept 2024Inspection
Found deficiencies in ABST use and data consistency with resident rosters and care plans.
Licensing—Failed to use an ABST
19 Sept 2024Inspection
19 Sept 2024Inspection
Investigated an allegation of verbal abuse toward a resident and found the resident was not protected from such abuse, with profanity used by a staff member in responding to a help request.
Licensing—Failed to protect resident from verbal abuse
11 Sept 2024Kitchen
11 Sept 2024Kitchen
Identified ongoing sanitation and maintenance deficiencies in the kitchen and repeated administration compliance issues across multiple visits.
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Administration Compliance
15 Jun 2024Abuse: Neglect
15 Jun 2024Abuse: Neglect
Investigated and found a deficient medication administration system that left a resident without prescribed medication because medications were expired, posing serious risk of harm.
Abuse—Failed to provide a safe medication administration system
23 Apr 2024Complaint
23 Apr 2024Complaint
Investigated a complaint found that daily dish cleaning assistance was not provided and medications were not administered as prescribed.
Deficiency—Service Plan: General
Deficiency—Systems: Treatment Orders
Deficiency—Involuntary Move-Out Criteria
01 Apr 2024Inspection
01 Apr 2024Inspection
Investigated a move-out requirement allegation and found that 30-day notice was not provided to the resident, the resident's legal representative, and the resident's case manager before an involuntary move-out.
Licensing—Failed to comply with move-out, transfer or discharge requirements
29 Jan 2024Validation
29 Jan 2024Validation
Found multiple deficiencies across evaluations, service plans, medication administration, staffing, training, fire safety, and activities, indicating failures to maintain current, individualized, and compliant care processes.
Deficiency—Comment
Deficiency—Resident Move-In and Eval: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Systems: Resident Right to Refuse
Deficiency—Systems: Medication Administration
Deficiency—Acuity-Based Staffing Tool
Deficiency—Acuity Based Staffing Tool - Abst Time
Deficiency—Acuity Based Staffing Tool - Updates & Plan
Deficiency—Training Within 30 Days: Direct Care Staff
Deficiency—Fire and Life Safety: Safety
Deficiency—Fire and Life Safety: Training For Residents
Deficiency—Inspections and Investigation: Insp Interval
Investigated a failure to provide a safe environment, resulting in neglect and abuse.
Licensing—Failed to provide safe environment
15 Jan 2024Inspection
15 Jan 2024Inspection
Found a failure to provide a safe environment that could harm a resident, and it was substantiated.
Licensing—Failed to provide safe environment
14 Sept 2023Abuse: Neglect
14 Sept 2023Abuse: Neglect
Investigated an incident where a resident was harmed and found a failure to provide a safe environment and abuse.
Abuse—Failed to provide safe environment
23 Aug 2023Abuse: Neglect
23 Aug 2023Abuse: Neglect
Investigated and found that care was not properly planned for a high fall risk resident, leading to a fall and injury. Violations were cited and a $250 fine assessed.
Abuse—Failed to properly plan care
25 Jul 2023Abuse: Neglect
25 Jul 2023Abuse: Neglect
Found unsafe care and supervision leading to a resident's falls and injuries. A $500 fine was assessed.
Abuse—Failed to provide safe environment
05 Jul 2023Inspection
05 Jul 2023Inspection
Found a failure to provide appropriate housekeeping services.
Licensing—Failed to provide appropriate housekeeping services
14 Jun 2023License Condition
14 Jun 2023License Condition
Found direct care staffing was insufficient to meet residents' scheduled and unscheduled needs.
Regulatory Action—Failed to meet the scheduled and unscheduled needs of residents
14 Jun 2023License Condition
14 Jun 2023License Condition
Investigated the allegation and found the facility failed to use ABST as required.
Regulatory Action—Failed to use an ABST
24 May 2023Abuse: Neglect
24 May 2023Abuse: Neglect
Found that staff did not follow the care plan for a high fall risk resident, resulting in an unwitnessed fall. A 750-dollar fine was assessed.
Abuse—Failed to follow care plan
24 May 2023Abuse: Neglect
24 May 2023Abuse: Neglect
Found staff failed to stay with a high fall risk resident as required by the care plan, leading to a fall and indicating neglect and abuse. A $750 fine was assessed.
Abuse—Failed to follow care plan
05 Apr 2023Complaint
05 Apr 2023Complaint
Investigated a complaint and identified multiple deficiencies related to meals, resident services (ADLs), staffing, acuity-based staffing, and building interior.
Deficiency—Staffing Requirements and Training: Staffing
Deficiency—Acuity-Based Staffing Tool
Deficiency—General Building Interior
04 Apr 2023Licensure
04 Apr 2023Licensure
Identified significant kitchen sanitation and repair deficiencies; a follow-up revisit showed substantial compliance with meal service and food sanitation rules.
Found a failure to provide a safe environment that put a resident at risk of harm.
Abuse—Failed to provide safe environment
13 Mar 2023Inspection
13 Mar 2023Inspection
Concluded that qualified awake direct care staff were not provided in sufficient numbers to meet residents' 24-hour needs.
Licensing—Failed to provide appropriate staffing
13 Mar 2023Inspection
13 Mar 2023Inspection
Found failure to provide three daily nutritious meals with snacks seven days a week, violating Oregon Administrative Rules.
Licensing—Failed to provide proper food/nutrition
13 Mar 2023Inspection
13 Mar 2023Inspection
Investigated a complaint and found an odor and cleanliness deficiency inside the premises.
Licensing—Failed to provide safe environment
30 Jan 2023Abuse: Neglect
30 Jan 2023Abuse: Neglect
Investigated and found that a high fall risk resident's care plan was not followed, resulting in a fall and facial injury.
Abuse—Failed to follow care plan
18 Jan 2023Abuse: Neglect
18 Jan 2023Abuse: Neglect
Investigated and found that a resident was put at risk when a staff member struck them with a golf club at the entrance, and the setting failed to provide a safe environment, constituting abuse and neglect.
Abuse—Failed to provide safe environment
06 Jan 2023Abuse: Neglect
06 Jan 2023Abuse: Neglect
Investigated an incident where a resident was harmed due to inadequate supervision, with substantiated abuse and neglect and a $375 fine assessed.
Abuse—Failed to provide safe environment
03 Jan 2023Inspection
03 Jan 2023Inspection
Found failure to provide assistance with toileting and bowel/bladder management.
Licensing—Failed to provide service
03 Jan 2023Inspection
03 Jan 2023Inspection
Found insufficient direct care staff to meet scheduled and unscheduled resident needs, violating staffing rules.
Licensing—Failed to provide appropriate staffing
31 Dec 2022Inspection
31 Dec 2022Inspection
Investigated a complaint and found that staff failed to provide a safe environment for a resident, leaving the resident unattended and staff outside smoking, which constitutes neglect and abuse.
Licensing—Failed to provide safe environment
28 Dec 2022Abuse: Neglect
28 Dec 2022Abuse: Neglect
Found neglect and abuse due to failure to provide care, leaving the resident in feces and urine and not cleaning. The resident was hospitalized and a fine was assessed.
Abuse—Failed to provide service
23 Dec 2022Inspection
23 Dec 2022Inspection
Found that a resident was not protected from financial exploitation and that the facility failed to prevent this exploitation when an alleged perpetrator bought a car from the resident and did not pay the balance.
Licensing—Failed to protect resident from financial exploitation
17 Nov 2022Abuse: Neglect
17 Nov 2022Abuse: Neglect
Investigated a complaint and found that an aggressive resident harmed a person in wheelchairs and the environment was unsafe; a fine was assessed.
Abuse—Failed to provide safe environment
11 Nov 2022Inspection
11 Nov 2022Inspection
Found that staff failed to assist residents with dressing, undressing, and toileting.
Licensing—Failed to provide service
02 Nov 2022Abuse: Neglect
02 Nov 2022Abuse: Neglect
Found violations for abuse and neglect due to failure to provide a safe environment that resulted in an injury.
Abuse—Failed to provide safe environment
01 Nov 2022Inspection
01 Nov 2022Inspection
Found that the memory care residence allowed individuals without a dementia diagnosis to reside there, violating dementia residency requirements.
Licensing—Failed to provide safe environment
16 Oct 2022Inspection
16 Oct 2022Inspection
Investigated a complaint alleging neglect of care and failure to provide service to a resident; findings substantiated.
Licensing—Failed to provide service
01 Oct 2022Inspection
01 Oct 2022Inspection
Investigated a licensing issue and found a failure to timely submit weekly vaccination reporting for residents, staff, and vaccinated individuals. The noncompliance lasted 30 days in September 2022.
Licensing—Failed to submit timely or adequate staffing documentation
13 Sept 2022Abuse: Neglect
13 Sept 2022Abuse: Neglect
Investigated alleged neglect related to medication administration; found failures to provide a safe medication administration system and to administer prescribed medications, resulting in a $500 fine.
Abuse—Failed to provide a safe medication administration system
01 Sept 2022Inspection
01 Sept 2022Inspection
Found that three daily nutritious, palatable meals were not provided as required.
Licensing—Failed to provide proper food/nutrition
01 Sept 2022Inspection
01 Sept 2022Inspection
Investigated the allegation and found that essential household services were not provided, affecting health and comfort.
Licensing—Failed to provide service
17 Aug 2022Abuse: Neglect
17 Aug 2022Abuse: Neglect
Found a failure to provide a safe medication administration system, resulting in a resident missing antidepressant medication for several days and lacking follow-up on orders.
Abuse—Failed to provide a safe medication administration system
15 Aug 2022Inspection
15 Aug 2022Inspection
Investigated an allegation of failing to provide services to assist residents with daily living activities and identified a violation.
Licensing—Failed to provide service
15 Aug 2022Inspection
15 Aug 2022Inspection
Found that three daily nutritious meals with snacks were not provided seven days a week as required.
Licensing—Failed to provide proper food/nutrition
01 Jul 2022Inspection
01 Jul 2022Inspection
Found failure to submit timely weekly reporting of vaccinated individuals, residents, and staff to the proper authority for June 1–30, 2022.
Licensing—Failed to submit timely or adequate staffing documentation
14 Jun 2022Abuse: Neglect
14 Jun 2022Abuse: Neglect
Found that a safe medication administration system was not provided, risking harm to a resident who did not receive prescribed medications for several weeks. A $500 fine was assessed.
Abuse—Failed to provide a safe medication administration system
31 May 2022Inspection
31 May 2022Inspection
Investigated the allegation that medication orders were not administered as prescribed and identified a violation of Oregon Administrative Rules.
Licensing—Failed to administer medication as ordered
19 Apr 2022Abuse: Neglect
19 Apr 2022Abuse: Neglect
Identified a failure to provide a safe medication administration system due to a computer system switchover that prevented access to weights and MAR documentation, leading to potential harm and a fine assessment.
Abuse—Failed to provide a safe medication administration system
13 Apr 2022Abuse: Neglect
13 Apr 2022Abuse: Neglect
Investigated a failure to provide a safe environment due to inadequate supervision, and found substantiated abuse/neglect with unsafe interactions between individuals.
Abuse—Failed to provide safe environment
30 Mar 2022Inspection
30 Mar 2022Inspection
Found deficiency for failure to provide three daily nutritious, platable meals as required.
Licensing—Failed to provide proper food/nutrition
15 Feb 2022Inspection
15 Feb 2022Inspection
Found a licensing violation for failing to provide a safe environment because residents' rooms smelled like animal urine.
Licensing—Failed to provide safe environment
15 Feb 2022Inspection
15 Feb 2022Inspection
Investigated a complaint and found that housekeeping services were not provided. The resident room was not clean.
Licensing—Failed to provide service
18 Jan 2022Inspection
18 Jan 2022Inspection
Determined that there was a failure to provide a daily program of social and recreational activities as required by rule.
Licensing—Failed to provide appropriate activities
29 Dec 2021Abuse: Neglect
29 Dec 2021Abuse: Neglect
Found neglect and abuse for failing to follow the care plan and provide wound care, causing unnecessary discomfort.
Abuse—Failed to follow care plan
19 Dec 2021Inspection
19 Dec 2021Inspection
Investigated a complaint alleging inadequate housekeeping; verified essential housekeeping services were not provided and tasks were performed by family members.
Licensing—Failed to provide appropriate housekeeping services
02 Dec 2021Abuse: Neglect
02 Dec 2021Abuse: Neglect
Found neglect and abuse due to failure to properly plan care and implement interventions for a resident's behavioral issues, resulting in a $500 fine.
Abuse—Failed to properly plan care
01 Dec 2021Abuse: Neglect
01 Dec 2021Abuse: Neglect
Investigated and found that a resident experienced emotional harm due to another resident's intoxicated and belligerent behavior, with insufficient care planning and interventions. A $500 fine was assessed.
Abuse—Failed to properly plan care
01 Dec 2021Abuse: Neglect
01 Dec 2021Abuse: Neglect
Investigated and found a failure to properly plan care and implement interventions, resulting in abuse and neglect.
Abuse—Failed to properly plan care
29 Nov 2021Abuse: Neglect
29 Nov 2021Abuse: Neglect
Identified deficiencies in pain medication availability that caused unnecessary pain and discomfort for Alleged Victims. Violations cited for medication access and protection of resident rights.
Abuse—Failed to have medication available
23 Nov 2021Abuse: Neglect
23 Nov 2021Abuse: Neglect
Investigated a complaint about care planning for a resident who refused assistance and was left unaddressed; found failures constituting neglect and abuse.
Abuse—Failed to properly plan care
11 Nov 2021Abuse: Neglect
11 Nov 2021Abuse: Neglect
Investigated a resident-on-resident incident and found the service plan was not adjusted for ongoing aggression, resulting in abuse and neglect.
Abuse—Failed to properly plan care
06 Nov 2021Abuse: Neglect
06 Nov 2021Abuse: Neglect
Investigated a report of abuse and neglect; found the environment was not safe and a resident was shoved, resulting in a $250 fine.
Abuse—Failed to provide safe environment
27 Oct 2021Abuse: Neglect
27 Oct 2021Abuse: Neglect
Investigated a failure to follow the care plan that led to a skin tear and bruising during a resident-to-resident interaction; identified as abuse and neglect.
Abuse—Failed to follow care plan
15 Oct 2021Inspection
15 Oct 2021Inspection
Investigated a medication administration incident and found a lack of a safe medication administration system. Violations were substantiated.
Licensing—Failed to provide a safe medication administration system
01 Oct 2021Inspection
01 Oct 2021Inspection
Found that a staff member gave another resident's medication and did not follow orders, and the medication administration system was unsafe; a fine was assessed.
Licensing—Failed to administer medication as ordered
01 Oct 2021Abuse: Neglect
01 Oct 2021Abuse: Neglect
Investigated a medication-availability complaint. Found that prescribed medications were not in stock, resulting in neglect and abuse; a $250 fine was assessed.
Abuse—Failed to have medication available
14 Sept 2021Abuse: Neglect
14 Sept 2021Abuse: Neglect
Investigated an abuse/neglect allegation; found care plan wasn't followed and a staff member hit a resident, with a $250 fine assessed.
Abuse—Failed to follow care plan
06 Sept 2021Abuse: Neglect
06 Sept 2021Abuse: Neglect
Investigated failures to plan care and safety measures for a resident with aggressive behavior. Found these deficiencies violated resident rights and amounted to abuse and neglect.
Abuse—Failed to properly plan care
04 Aug 2021Inspection
04 Aug 2021Inspection
Found that a staff member administered another resident's medication, causing an allergic reaction, and that there was a failure to maintain a safe medication administration system.
Licensing—Failed to provide a safe medication administration system
25 Jun 2021Abuse: Neglect
25 Jun 2021Abuse: Neglect
Investigated a medication administration incident found delays in giving medications due to staffing shortages, causing anxiety and constituting abuse and neglect.
Abuse—Failed to administer medication as ordered
24 Mar 2021Abuse: Neglect
24 Mar 2021Abuse: Neglect
Investigated and found a failure to provide a safe medication administration system, resulting in pain medication not being available as prescribed and causing pain and discomfort.
Abuse—Failed to provide a safe medication administration system
19 Mar 2021Abuse: Neglect
19 Mar 2021Abuse: Neglect
Investigated allegations of neglect and abuse related to inadequate care planning and failure to address a resident's suicidal ideations. A $1,500 fine was assessed after a resident was found with a pendant wrapped around a trapeze and neck.
Abuse—Failed to properly plan care
08 Mar 2021Abuse: Neglect
08 Mar 2021Abuse: Neglect
Found that a safe medication administration system was not provided, resulting in a resident not receiving pain medications on multiple days and experiencing discomfort; a $500 fine was assessed.
Abuse—Failed to provide a safe medication administration system
07 Mar 2021Abuse: Neglect
07 Mar 2021Abuse: Neglect
Found neglect for failing to provide a safe environment, resulting in multiple falls and risk of serious harm.
Abuse—Failed to provide safe environment
11 Feb 2021Abuse: Neglect
11 Feb 2021Abuse: Neglect
Investigated a complaint about medication safety and found a failure to provide a safe medication administration system, resulting in missed blood sugar checks. Found no wrongdoing by an alleged perpetrator.
Abuse—Failed to provide a safe medication administration system
09 Jan 2021Abuse: Neglect
09 Jan 2021Abuse: Neglect
Investigated and found neglect due to failure to provide a safe medication administration system, which led to a resident requiring hospital observation after missing blood sugar medication. A fine of $1125 was assessed.
Abuse—Failed to provide a safe medication administration system
12 Dec 2020Abuse: Neglect
12 Dec 2020Abuse: Neglect
Found a violation of safe medication administration resulting in hospital transport and assessed a $1,500 fine.
Abuse—Failed to provide a safe medication administration system
25 Nov 2020Abuse: Neglect
25 Nov 2020Abuse: Neglect
Found a failure to administer medication as ordered, resulting in the resident's hospital visit.
Abuse—Failed to provide a safe medication administration system
16 Nov 2020Inspection
16 Nov 2020Inspection
Investigated a complaint and found failures in medication administration that created risk of harm due to an unsafe system. The finding involved not administering prescribed antibiotics.
Licensing—Failed to provide a safe medication administration system
02 Oct 2020Abuse: Neglect
02 Oct 2020Abuse: Neglect
Investigated a medication safety incident and found a failure to provide a safe medication administration system that led to hospital transfer and injury. A monetary sanction was assessed.
Abuse—Failed to provide a safe medication administration system
21 Sept 2020Inspection
21 Sept 2020Inspection
Investigated and substantiated a licensing violation involving neglect and verbal abuse that harmed a resident's safety and dignity.
Licensing—Failed to provide safe environment
28 Aug 2020Abuse: Neglect
28 Aug 2020Abuse: Neglect
Investigated an abuse/neglect allegation and found a failure to provide a safe medication administration system, leaving a resident without medications at consistent times and at risk of serious harm.
Abuse—Failed to provide a safe medication administration system
14 Aug 2020Abuse: Neglect
14 Aug 2020Abuse: Neglect
Found that the provider failed to provide a safe medication administration system, resulting in a resident going multiple days without pain medication. This caused ongoing discomfort and was identified as abuse and neglect.
Abuse—Failed to provide a safe medication administration system
18 Jul 2020Inspection
18 Jul 2020Inspection
Found a violation for failing to protect a resident from verbal abuse.
Licensing—Failed to protect resident from verbal abuse
18 Jul 2020Inspection
18 Jul 2020Inspection
Investigated a verbal abuse allegation. Found that a staff member used inappropriate language toward a resident and that the resident was not protected from verbal abuse.
Licensing—Failed to protect resident from verbal abuse
18 Jul 2020Inspection
18 Jul 2020Inspection
Determined that a caregiver failed to follow the resident’s care plan for nutritional needs and refused a breakfast item, creating neglect and abuse risk; violations were found.
Licensing—Failed to provide service
18 Jul 2020Inspection
18 Jul 2020Inspection
Investigated and found that a resident did not receive proper meal accommodations when a meal was not prepared correctly, causing discomfort and loss of dignity, and protection from neglect was not maintained.
Licensing—Failed to assure resident rights
18 Jul 2020Inspection
18 Jul 2020Inspection
Found that a staff member used inappropriate language toward and in front of a resident, which amounted to verbal/emotional abuse, and that the provider failed to protect the resident from abuse.
Licensing—Failed to protect resident from verbal abuse
05 Jul 2020Abuse: Neglect
05 Jul 2020Abuse: Neglect
Found neglect and abuse due to failure to follow the resident's care plan, leaving the resident without toileting assistance for about seven hours and causing loss of dignity; a $500 fine was assessed.
Abuse—Failed to follow care plan
25 Jun 2020Abuse: Neglect
25 Jun 2020Abuse: Neglect
Found care plan not followed, leading to a resident fall and skin injury, with a finding of neglect/abuse and a fine assessed.
Abuse—Failed to follow care plan
28 May 2020Abuse: Neglect
28 May 2020Abuse: Neglect
Found that a safe medication administration system was not provided, risking harm by medications not being administered as ordered.
Abuse—Failed to provide a safe medication administration system
14 May 2020Abuse: Neglect
14 May 2020Abuse: Neglect
Found violations involving an unsafe medication administration system that left a resident without necessary medications for several days, resulting in unnecessary discomfort; a $1,500 fine was assessed.
Abuse—Failed to provide a safe medication administration system
26 Mar 2020Inspection
26 Mar 2020Inspection
Investigated an allegation of failing to follow the care plan and confirmed a failure to ensure the implementation of services per the care plan.
Licensing—Failed to follow care plan
12 Feb 2020Inspection
12 Feb 2020Inspection
Determined a deficiency in providing a homelike environment due to unpleasant interior odors.
Licensing—Failed to provide a homelike environment
12 Feb 2020Inspection
12 Feb 2020Inspection
Investigated a complaint that call light responses were delayed. Found deficiencies in keeping interior and exterior materials and equipment clean and in good repair.
Licensing—Failed to answer call light in a timely manner
12 Feb 2020Inspection
12 Feb 2020Inspection
Identified a deficiency in maintaining exterior grounds free of litter; outdoor dog area unusable due to fecal matter.
Licensing—Failed to provide a homelike environment
02 Feb 2020Abuse: Neglect
02 Feb 2020Abuse: Neglect
Investigated and found neglect of care and abuse due to failure to implement interventions and an appropriate care plan after a hip fracture, resulting in two additional injury falls and hospital transport. A $2,500 fine was assessed.
Abuse—Failed to assure resident was safe
10 Jan 2020Abuse: Neglect
10 Jan 2020Abuse: Neglect
Found a failure to provide a safe medication administration system, resulting in a resident going approximately four days without necessary antibiotics and worsening.
Abuse—Failed to provide a safe medication administration system
27 Dec 2019Abuse: Neglect
27 Dec 2019Abuse: Neglect
Found a failure to provide a safe medication administration system, leading to an extra narcotic dose and potential harm to a resident. The finding noted the extra dose placed the resident at risk of harm.
Abuse—Failed to provide a safe medication administration system
27 Dec 2019Abuse: Neglect
27 Dec 2019Abuse: Neglect
Found deficiencies in medication administration safety that placed a resident at risk by receiving scheduled narcotics too early and too close to the prior dose; a $375 fine was assessed.
Abuse—Failed to provide a safe medication administration system
27 Dec 2019Abuse: Neglect
27 Dec 2019Abuse: Neglect
Investigated a medication administration complaint and found a failure to provide a safe system, risking harm by early and closely spaced narcotic doses.
Abuse—Failed to provide a safe medication administration system
03 Dec 2019Abuse: Neglect
03 Dec 2019Abuse: Neglect
Found a failure to provide a safe medication administration system that led to missing pain medication and unnecessary discomfort, constituting neglect and abuse.
Abuse—Failed to provide a safe medication administration system
23 Nov 2019Abuse: Neglect
23 Nov 2019Abuse: Neglect
Found neglect occurred when a resident experienced an unwitnessed fall resulting in a broken collarbone due to not following the care plan.
Abuse—Failed to follow care plan
30 Oct 2019Inspection
30 Oct 2019Inspection
Found a violation due to a nonfunctioning call system that left a resident without assistance for about two hours.
Licensing—Failed to assure resident was safe
01 Jul 2019Inspection
01 Jul 2019Inspection
Found a violation for failing to protect a resident's money from theft, leading to financial exploitation.
Licensing—Failed to protect resident from financial exploitation
21 May 2019Abuse: Neglect
21 May 2019Abuse: Neglect
Found failure to provide a safe medication administration system, resulting in a serious risk of harm from not administering medications as ordered. Violations were cited for related regulatory requirements.
Abuse—Failed to provide a safe medication administration system
14 May 2019Inspection
14 May 2019Inspection
Investigated the allegation of failing to report suspected abuse and found that injuries of unknown cause were not reported to Adult Protective Services.
Licensing—Failed to report potential or suspected abuse
05 Mar 2019Abuse: Physical Abuse
05 Mar 2019Abuse: Physical Abuse
Investigated a physical abuse allegation and found neglect of basic care that could affect health and safety.
Abuse—Failed to protect resident from rough treatment
25 Oct 2018Abuse: Neglect
25 Oct 2018Abuse: Neglect
Found neglect due to failure to provide a safe medication administration system, creating risk of harm when narcotic medication was not provided; a $188 fine was assessed.
Abuse—Failed to provide a safe medication administration system
09 Oct 2018Abuse: Neglect
09 Oct 2018Abuse: Neglect
Investigated neglect due to inadequate supervision and care planning that led to multiple falls and risk of serious harm; a fine was assessed.
Abuse—Failed to adequately care plan related to falls
23 Aug 2018Abuse: Neglect
23 Aug 2018Abuse: Neglect
Investigated a neglect allegation and found a caregiver allowed an attack between residents in the dining room, causing potential harm. A $750 fine was assessed.
Abuse—Failed to provide service
23 Aug 2018Abuse: Neglect
23 Aug 2018Abuse: Neglect
Found neglect where a resident was allowed into another resident's room and struck them, creating potential for serious harm.
Abuse—Failed to follow care plan
20 Aug 2018Abuse: Neglect
20 Aug 2018Abuse: Neglect
Found neglect due to lack of adequate supervision, creating risk of serious harm to AV1 and AV2. A $375 fine was assessed.
Abuse—Failed to properly plan care
13 Aug 2018Abuse: Neglect
13 Aug 2018Abuse: Neglect
Investigated a neglect allegation and identified a failure to follow the care plan that led to harm to residents.
Abuse—Failed to follow care plan
13 Aug 2018Abuse: Neglect
13 Aug 2018Abuse: Neglect
Found neglect by not providing frequent checks on AV1, resulting in physical harm to AV1.
Abuse—Failed to follow care plan
06 Aug 2018Abuse: Neglect
06 Aug 2018Abuse: Neglect
Identified a deficiency for failing to protect residents from harm and imposed a $375 fine.
Abuse—Failed to provide safe environment
31 Jul 2018Abuse: Neglect
31 Jul 2018Abuse: Neglect
Investigated and found neglect in care planning that resulted in physical harm to a resident.
Abuse—Failed to properly plan care
31 Jul 2018Abuse: Neglect
31 Jul 2018Abuse: Neglect
Found neglect due to failing to adequately plan care, resulting in physical harm to residents.
Abuse—Failed to properly plan care
09 Jun 2018Abuse: Neglect
09 Jun 2018Abuse: Neglect
Found neglect by a person responsible for providing care that failed to protect a resident from abuse. A $375 fine was assessed.
Abuse—Failed to provide safe environment
25 May 2018Abuse: Neglect
25 May 2018Abuse: Neglect
Investigated the neglect allegation and found failure to follow the care plan and provide appropriate care, resulting in a substantiated finding and a $2,500 fine.
Abuse—Failed to follow care plan
24 May 2018Abuse: Financial abuse
24 May 2018Abuse: Financial abuse
Investigated the financial abuse allegation and concluded that a resident's resources were wrongfully taken.
Abuse—Failed to provide safe environment
08 May 2018Abuse: Neglect
08 May 2018Abuse: Neglect
Found neglect due to failure to provide care, supervision, and services necessary to maintain physical health, creating risk of harm and discomfort. A $375 fine was assessed.
Abuse—Failed to properly plan care
16 Apr 2018Inspection
16 Apr 2018Inspection
Investigated a complaint and found a failure to provide a safe environment for residents.
Licensing—Failed to provide safe environment
16 Apr 2018Inspection
16 Apr 2018Inspection
Found that residents were not protected from inappropriate interactions, resulting in a $1,125 fine.
Licensing—Failed to provide safe environment
16 Apr 2018Abuse: Neglect
16 Apr 2018Abuse: Neglect
Investigated an allegation of failing to provide a safe environment and identified a deficiency related to resident safety.
Abuse—Failed to provide safe environment
02 Apr 2018Abuse: Neglect
02 Apr 2018Abuse: Neglect
Investigated the complaint and found a failure to adequately plan care related to falls, with a fine assessed.
Abuse—Failed to adequately care plan related to falls
15 Mar 2018Abuse: Neglect
15 Mar 2018Abuse: Neglect
Found that residents were not protected from inappropriate interaction.
Abuse—Failed to follow care plan
23 Feb 2018Inspection
23 Feb 2018Inspection
Investigated the abuse reporting allegation and found failure to report suspected abuse.
Licensing—Failed to report potential or suspected abuse
23 Feb 2018Abuse: Neglect
23 Feb 2018Abuse: Neglect
Investigated a complaint and found a failure to provide a safe environment, resulting in a $2,500 fine.
Abuse—Failed to provide service
15 Feb 2018Inspection
15 Feb 2018Inspection
Found violations of licensing rules related to service provision.
Licensing—Failed to provide service
12 Feb 2018Abuse: Neglect
12 Feb 2018Abuse: Neglect
Found failure to intervene when resident's condition changed, resulting in a substantiated neglect finding and a $1,500 fine.
Abuse—Failed to intervene when resident's condition changed
12 Feb 2018Inspection
12 Feb 2018Inspection
Investigated an allegation of failing to report suspected abuse and concluded there was a failure to report suspected abuse. A $750 fine was assessed.
Licensing—Failed to report potential or suspected abuse
14 Nov 2017Inspection
14 Nov 2017Inspection
Determined that care was not followed per the plan, resulting in inappropriate care.
Licensing—Failed to follow care plan
14 Nov 2017Inspection
14 Nov 2017Inspection
Determined that appropriate housekeeping services were not provided. The allegation was substantiated.
Licensing—Failed to provide appropriate housekeeping services
24 Jul 2017Abuse: Physical Abuse
24 Jul 2017Abuse: Physical Abuse
Investigated an allegation of physical abuse and found a failure to protect a resident from inappropriate physical contact.
Abuse—Failed to protect resident from rough treatment
21 Mar 2017Inspection
21 Mar 2017Inspection
Investigated the allegation of a failure to provide a safe environment and found noncompliance, with a $200 fine assessed.
Licensing—Failed to provide safe environment
01 Feb 2017Abuse: Neglect
01 Feb 2017Abuse: Neglect
Found that a resident was not protected from nonconsensual sexual contact by another resident.
Abuse—Failed to protect resident from inappropriate sexual contact
05 Jan 2015Abuse: Neglect
05 Jan 2015Abuse: Neglect
Investigated an allegation of neglect and found failure to properly plan care, with potential for moderate harm to a resident.
Abuse—Failed to properly plan care
08 Oct 2014Abuse: Financial abuse
08 Oct 2014Abuse: Financial abuse
Investigated an allegation of financial abuse and found a failure to protect a resident from theft.
Abuse—Failed to provide safe environment
02 Sept 2014Abuse: Financial abuse
02 Sept 2014Abuse: Financial abuse
Investigated an allegation of financial abuse and failure to provide a safe environment, found that a secure environment was not provided for a resident.
Abuse—Failed to provide safe environment
02 Jul 2014Abuse: Financial abuse
02 Jul 2014Abuse: Financial abuse
Investigated an abuse allegation and found a resident's property was not protected from theft, resulting in a $250 fine.
Abuse—Failed to provide safe environment
24 May 2014Abuse: Financial abuse
24 May 2014Abuse: Financial abuse
Investigated the allegation of financial abuse and found the RV was not protected from theft.
Abuse—Failed to provide safe environment
29 Apr 2014Inspection
29 Apr 2014Inspection
Found a safety deficiency due to failure to address resident behavior.
Licensing—Failed to address resident's behavior
22 Apr 2014Abuse: Financial abuse
22 Apr 2014Abuse: Financial abuse
Investigated a financial abuse allegation and found a failure to protect a resident from theft of $200.
Abuse—Failed to provide safe environment
14 Jan 2014Abuse: Neglect
14 Jan 2014Abuse: Neglect
Found violations involving failure to protect a resident from harm; a $2,500 fine was assessed.
Abuse—Failed to intervene when resident's condition changed
23 Sept 2010Inspection
23 Sept 2010Inspection
Investigated the allegation and found the care plan was not followed, resulting in a substantiated licensing violation with minor harm potential.
Licensing—Failed to follow care plan
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