Supportive presence during end-of-life transitions
Strong family communication and involvement
Helpful admissions and tour experience
Long-tenured staff and continuity of caregivers
Convenient location near medical services
Well-regarded meal service
Cons
Inconsistent staff responsiveness and attentiveness
Gaps in medication administration and oversight
Housekeeping and food-safety deficiencies in resident rooms
Delayed maintenance response and HVAC reliability issues
Staff conduct during personal-care and transfers
Poor transparency and communication with families during incidents
High leadership turnover and inconsistent corrective action
Variable dining quality and meal consistency
Allegations of narcotics diversion and medication control gaps
Summary of reviews
Feedback for this facility is highly mixed, with a clear split between families who describe strong personal care and those who raise substantive operational concerns. On the positive side, many accounts highlight an engaged, compassionate caregiving team, a warm and welcoming culture, and active programming that keeps residents socially engaged. Several families praised admissions and tour interactions as helpful and professional, and some specifically noted sustained, supportive presence during end-of-life transitions.
Care quality narratives vary. Numerous reviewers praised individual caregivers as attentive, knowledgeable, and compassionate, and some described good post-move-in communication and family involvement. Conversely, other accounts describe inconsistent responsiveness, failures to follow care plans or medication schedules, and concerns about conduct during personal-care tasks and resident transfers. There are also serious claims regarding medication controls; these include allegations of narcotics diversion, which indicate potential gaps in medication-administration oversight that merit close review by prospective families and regulators.
Dining and activities are similarly polarized. Many residents and families appreciate the activities calendar, engagement opportunities, and positive meal experiences. At the same time, a subset of accounts describes inconsistent meal quality and food-safety or housekeeping issues within resident rooms that affect perceptions of the dining program. Prospective families should observe mealtimes and ask about menu rotation, food-safety protocols, and how the facility handles resident-specific dietary needs.
Facility maintenance and housekeeping received mixed feedback. Some describe common areas as clean and well maintained, while others cite sanitation concerns in resident rooms, delayed housekeeping, and slow response to maintenance requests — including prolonged HVAC or air-conditioning issues in certain cases. These observations point to variability in operational follow-through rather than a uniform standard of care across the community.
Management and communication surfaced as a recurring theme. Positive reports note clear, helpful communication and accessible staff during move-in and routine interactions. Negative feedback emphasizes poor transparency during incidents, frequent leadership turnover, and a perception that corrective actions have not been consistently effective. These organizational patterns can materially affect family confidence; asking about leadership stability, staff turnover rates, and quality-assurance processes is advisable.
In summary, the facility appears to provide meaningful strengths in personal warmth, certain caregiving relationships, social programming, and, for many, satisfactory end-of-life support. However, recurring operational concerns — particularly inconsistent staff responsiveness, medication-administration controls, housekeeping/food-safety practices, and maintenance follow-through — create variability in resident experience. Prospective residents and families should arrange an in-person visit, observe daily routines (mealtimes, activities, staff–resident interactions), request documentation on medication and incident protocols, and ask for references to assess consistency before making a placement decision.
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Location
Gresham Pointe Senior Living is located at 25200 SE Stark St, Gresham, OR, 97030.
People often ask...
Gresham Pointe Senior Living offers independent living and assisted living.
There are 18 photos of Gresham Pointe Senior Living on Mirador.
The full address for this community is 25200 SE Stark St, Gresham, OR 97030.
No, Gresham Pointe Senior Living 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.
Observed extensive kitchen sanitation and storage deficiencies, with ongoing noncompliance documented across visits. Documented failure to correct deficiencies within the required timeframes.
Deficiency—Staffing Requirements and Training: Staffing
Deficiency—Acuity Based Staffing Tool - Updates & Staffing Plan
Deficiency—Staffing Requirements and Training ? Pre-service
Deficiency—Training Within 30 Days of Hire ? Direct Care Staff
Deficiency—Fire and Life Safety: Safety
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Staffing Requirements and Training ? Pre-service
21 Nov 2025Abuse: Neglect
21 Nov 2025Abuse: Neglect
Investigated a resident's fall and found failure to monitor a change in condition after the injury. A $500 fine was assessed.
Abuse—Failed to intervene when resident's condition changed
22 Jul 2025Inspection
22 Jul 2025Inspection
Found that required records were not provided to the Department upon request.
Licensing—Failed to assure resident rights
22 Jul 2025Inspection
22 Jul 2025Inspection
Investigated and identified deficiencies in the preparation, completeness, accuracy, and preservation of resident records.
Licensing—Failed to assure resident rights
22 Jul 2025Inspection
22 Jul 2025Inspection
Investigated the allegation and found that records were not provided to the department upon request.
Licensing—Failed to assure resident rights
09 Jun 2025Kitchen
09 Jun 2025Kitchen
Identified deficiencies in kitchen sanitation, equipment repair, and staff food handler certification compliance, and gaps in responding to prior corrections.
Deficiency—Staffing Requirements and Training ? Pre-service
Deficiency—Inspections and Investigation: Insp Interval
31 Mar 2025Abuse: Neglect
31 Mar 2025Abuse: Neglect
Found violations of resident rights due to improper catheter care and extended wait times, indicating neglect and abuse.
Abuse—Failed to provide service
05 Dec 2024Abuse: Neglect
05 Dec 2024Abuse: Neglect
Found a failure to provide a safe medication administration system when a 5 mg narcotic order was entered as 5 ml, resulting in vomiting after administration.
Abuse—Failed to provide a safe medication administration system
22 Nov 2024Abuse: Neglect
22 Nov 2024Abuse: Neglect
Investigated and found failure to follow the care plan for incontinence care and skin checks, resulting in a urine-soaked mattress and fungal infections.
Abuse—Failed to follow care plan
14 Mar 2024Licensure
14 Mar 2024Licensure
Identified extensive deficiencies in kitchen sanitation, food storage, and infection control during two visits, with multiple areas needing cleaning, repair, and improved practices. Observed issues included unclean equipment, improper food temperatures, and inadequate hand hygiene.
Investigated and found a failure to provide a safe environment.
Regulatory Action—Failed to provide safe environment
11 Feb 2024Abuse: Neglect
11 Feb 2024Abuse: Neglect
Found a failure to provide a safe environment that allowed an elopement and resulted in injury, with a $188 fine assessed.
Abuse—Failed to provide safe environment
30 Oct 2023Inspection
30 Oct 2023Inspection
Found a violation of resident rights due to sexual abuse and failure to protect a resident. Evidence included video showing the alleged perpetrator exposing genitals and forcing the resident to touch them.
Licensing—Failed to protect resident from inappropriate sexual contact
16 Oct 2023Abuse: Neglect
16 Oct 2023Abuse: Neglect
Found deficiencies in care planning for a resident with a fall history that led to an injury and discomfort; a fine was assessed.
Abuse—Failed to properly plan care
16 Oct 2023Validation
16 Oct 2023Validation
Found multiple regulatory deficiencies across administration, resident care planning, health services, medication management, and safety, indicating numerous violations were cited.
Deficiency—Resident Move-In and Eval: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Service Plan: Service Planning Team
Deficiency—Change of Condition and Monitoring
Deficiency—Resident Health Services
Deficiency—Res Hlth Srvc: On- and Off-Site Health Srvc
Deficiency—Systems: Treatment Orders
Deficiency—Systems: Resident Right to Refuse
Deficiency—Systems: Medication Administration
Deficiency—Systems: Psychotropic Medication
Deficiency—Acuity-Based Staffing Tool
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
16 Oct 2023Abuse: Neglect
16 Oct 2023Abuse: Neglect
Found violations for failure to follow a resident's care plan, leading to missed showers for about 3-4 weeks and skin infections.
Abuse—Failed to follow care plan
08 Oct 2023Abuse: Neglect
08 Oct 2023Abuse: Neglect
Found a failure to provide a safe medication administration system, resulting in a resident not receiving anxiety medication as ordered and experiencing undue discomfort.
Abuse—Failed to provide a safe medication administration system
07 Oct 2023Abuse: Neglect
07 Oct 2023Abuse: Neglect
Investigated found that staff were not trained properly to use a Hoyer lift, causing a lift to tip over and injure a resident; this was identified as abuse and neglect.
Abuse—Failed to provide inservice
03 Oct 2023License Condition
03 Oct 2023License Condition
Investigated an ABST usage allegation and found that an ABST was not used.
Regulatory Action—Failed to use an ABST
29 Sept 2023Abuse: Neglect
29 Sept 2023Abuse: Neglect
Found a failure to provide a safe medication administration system, resulting in a delayed reordering of PRN narcotics and two days of unnecessary pain for the resident.
Abuse—Failed to provide a safe medication administration system
08 Aug 2023Abuse: Neglect
08 Aug 2023Abuse: Neglect
Found neglect due to failure to follow a resident's care plan, causing pain from an undrained catheter.
Abuse—Failed to follow care plan
28 Jul 2023Complaint
28 Jul 2023Complaint
Investigated and identified deficiencies in self-administration medication supervision. Found that staff did not visually observe residents taking meds and that the acuity-based staffing tool did not include all required ADL components.
Deficiency—Licensing Complaint Investigation
Deficiency—Systems: Self-Administration of Meds
Deficiency—Acuity-Based Staffing Tool
25 Jul 2023Abuse: Neglect
25 Jul 2023Abuse: Neglect
Found neglect and abuse due to failure to follow the resident's catheter care plan, causing pain and discomfort; a $250 fine was assessed.
Abuse—Failed to follow care plan
18 Jul 2023Inspection
18 Jul 2023Inspection
Investigated the allegation of unsafe medication administration and determined that a resident who self-administers medication lacked an approved physician order, quarterly self-administration evaluations, and on-unit prescriptions.
Licensing—Failed to provide a safe medication administration system
17 Jul 2023Abuse: Neglect
17 Jul 2023Abuse: Neglect
Investigated a complaint and found neglect due to failure to properly care plan for catheter management, causing pain and discomfort.
Abuse—Failed to properly plan care
14 Jul 2023Abuse: Neglect
14 Jul 2023Abuse: Neglect
Investigated a complaint and found that prescribed pain medication was not administered daily, causing unreasonable discomfort to a resident.
Abuse—Failed to administer medication as ordered
04 Apr 2023Licensure
04 Apr 2023Licensure
Identified deficiencies in kitchen cleanliness related to food sanitation rules; a later follow-up concluded substantial compliance.
Found a failure to provide a safe medication administration system, resulting in the resident going without pain medication on at least two occasions and experiencing discomfort; a $500 fine was assessed.
Abuse—Failed to administer medication as ordered
07 Dec 2022Abuse: Neglect
07 Dec 2022Abuse: Neglect
Found that a resident's care plan was not followed, causing discomfort and loss of dignity; a $500 fine was assessed.
Abuse—Failed to follow care plan
25 Jul 2022Abuse: Neglect
25 Jul 2022Abuse: Neglect
Found violations for failure to properly plan care related to a resident's fall history, leading to pain and injury.
Abuse—Failed to properly plan care
08 Apr 2022Abuse: Neglect
08 Apr 2022Abuse: Neglect
Found that AV's care plan to apply numbing gel to AV's gums was not followed, resulting in weight loss and pain, and a $500 fine was assessed.
Abuse—Failed to follow care plan
05 Feb 2022Abuse: Neglect
05 Feb 2022Abuse: Neglect
Investigated a complaint and found neglect of care and abuse due to failure to provide appropriate services, resulting in a resident being found soiled and needing a shower.
Abuse—Failed to provide service
13 Dec 2021Validation
13 Dec 2021Validation
Identified multiple deficiencies across abuse reporting, resident evaluations, service planning, condition monitoring, coordination with outside providers, staffing, and environmental maintenance. Found violations of several regulations.
Deficiency—Resident Move-In and Eval: 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: Resident Right to Refuse
Deficiency—Staffing Requirements and Training: Staffing
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Doors, Walls, Elevators, Odors
18 Aug 2021Abuse: Neglect
18 Aug 2021Abuse: Neglect
Found that a resident's care plan wasn't followed, causing an extended wait for hygiene assistance and resulting discomfort. A $250 fine was assessed.
Abuse—Failed to follow care plan
13 Jan 2021Abuse: Neglect
13 Jan 2021Abuse: Neglect
Found violations involving protection of a resident from financial exploitation and improper handling of funds, with a fine assessed.
Abuse—Failed to protect resident from financial exploitation
18 Nov 2020Abuse: Neglect
18 Nov 2020Abuse: Neglect
Found neglect of care and violation of resident rights due to failure to provide breakfast after a request. A $500 fine was assessed.
Abuse—Failed to provide service
06 Aug 2020Inspection
06 Aug 2020Inspection
Determined that qualified awake direct care staff were not available in sufficient numbers to meet residents' 24-hour needs.
Licensing—Failed to assure a qualified caregiver was present
27 May 2020Abuse: Neglect
27 May 2020Abuse: Neglect
Investigated an allegation of delayed call-light responses and found repeated long response times that caused discomfort and neglect.
Abuse—Failed to answer call light in a timely manner
13 Feb 2020Abuse: Neglect
13 Feb 2020Abuse: Neglect
Determined that a resident was verbally abused and protection failed, constituting neglect and abuse; a fine was assessed.
Abuse—Failed to protect resident from verbal abuse
14 Dec 2019Abuse: Neglect
14 Dec 2019Abuse: Neglect
Found that a resident safety failure occurred when an unknown visitor was in the room, causing the resident to feel unsafe and emotionally uncomfortable; a $250 fine was assessed.
Abuse—Failed to assure resident was safe
24 Sept 2019Abuse: Neglect
24 Sept 2019Abuse: Neglect
Found a deficiency for failing to provide a safe medication administration system, resulting in incorrect medication administration for over a week and risk of harm.
Abuse—Failed to provide a safe medication administration system
17 Aug 2019Abuse: Financial abuse
17 Aug 2019Abuse: Financial abuse
Investigated a complaint about financial exploitation and found neglect of basic care or services that resulted in financial loss for a resident.
Abuse—Failed to protect resident from financial exploitation
03 Oct 2018Inspection
03 Oct 2018Inspection
Investigated the allegation of inadequate staffing and found insufficient staffing.
Licensing—Failed to provide appropriate staffing
03 Oct 2018Condition
03 Oct 2018Condition
Investigated a complaint and found a deficiency for failing to provide a safe environment.
Regulatory Action—Failed to provide safe environment
30 Sept 2018Inspection
30 Sept 2018Inspection
Investigated an allegation of neglect and found that basic care and services were not provided, resulting in significant harm. Violations cited.
Licensing—Failed to maintain a safe physical environment
20 Sept 2018Abuse: Neglect
20 Sept 2018Abuse: Neglect
Identified neglect by failing to provide basic care when a resident's condition changed, creating a risk of serious harm.
Abuse—Failed to intervene when resident's condition changed
12 Jul 2018Abuse: Financial abuse
12 Jul 2018Abuse: Financial abuse
Found that a resident was not protected from financial exploitation and a fine was assessed.
Abuse—Failed to protect resident from financial exploitation
29 Mar 2018Abuse: Financial abuse
29 Mar 2018Abuse: Financial abuse
Found a financial abuse allegation and a failure to protect a resident from theft, with a $500 fine assessed.
Abuse—Failed to provide safe environment
04 Dec 2017Inspection
04 Dec 2017Inspection
Identified a deficiency related to required postings.
Licensing—Failed to make facility or resident records accessible
04 Dec 2017Inspection
04 Dec 2017Inspection
Determined a staffing deficiency that affected residents' scheduled and unscheduled needs, including related 911 calls due to insufficient staff.
Licensing—Failed to provide appropriate staffing
04 Dec 2017Inspection
04 Dec 2017Inspection
Investigated the complaint and found a lack of policies for medical emergencies.
Licensing—Failed to provide safe environment
31 Jul 2017Abuse: Financial abuse
31 Jul 2017Abuse: Financial abuse
Investigated the allegation of financial exploitation and found residents were not protected from theft.
Abuse—Failed to protect resident from financial exploitation
14 Jul 2017Inspection
14 Jul 2017Inspection
Identified a housekeeping failure and odor issues, with multiple resident rooms smelling of urine and the building not kept free from unpleasant odors.
Licensing—Failed to provide appropriate housekeeping services
14 Jul 2017Inspection
14 Jul 2017Inspection
Found a deficiency where the service plan did not reflect resident preferences.
Licensing—Failed to properly plan care
14 Jul 2017Inspection
14 Jul 2017Inspection
Investigated a complaint and found a deficiency for failing to keep the building interior clean and in good repair, including carpet stains in multiple resident rooms.
Licensing—Failed to provide appropriate housekeeping services
27 May 2017Inspection
27 May 2017Inspection
Found a deficiency for not providing a safe environment.
Licensing—Failed to properly plan care
18 May 2016Inspection
18 May 2016Inspection
Investigated the allegation that medication records were not kept current or accurate. Findings showed an inadequate medication system.
Licensing—Failed to keep medication record current or accurate
25 Dec 2015Inspection
25 Dec 2015Inspection
Investigated and found a failure to provide a safe environment.
Licensing—Failed to provide safe environment
22 May 2015Inspection
22 May 2015Inspection
Determined that a safe environment was not provided.
Licensing—Failed to provide safe environment
26 Apr 2015Abuse: Financial abuse
26 Apr 2015Abuse: Financial abuse
Investigated an allegation of an unsafe environment and found a safety deficiency. The deficiency involved failure to protect medications from theft.
Abuse—Failed to provide safe environment
26 Feb 2015Abuse: Neglect
26 Feb 2015Abuse: Neglect
Investigated an allegation of neglect and found the medication was not administered as ordered. A $300 fine was assessed.
Abuse—Failed to administer medication as ordered
08 Jun 2014Abuse: Neglect
08 Jun 2014Abuse: Neglect
Investigated the allegation that medical treatment ordered was not provided; found that appropriate care was not provided, with a substantiated finding and a $300 fine.
Abuse—Failed to provide medical treatment as ordered
07 May 2014Inspection
07 May 2014Inspection
Investigated and found that medication was not administered as ordered.
Licensing—Failed to administer medication as ordered
21 Apr 2014Inspection
21 Apr 2014Inspection
Investigated an allegation of unsafe medication administration and found the medication system was not adequately maintained.
Licensing—Failed to provide a safe medication administration system
05 Apr 2014Inspection
05 Apr 2014Inspection
Found a deficiency in providing the reported victim's medication as ordered.
Licensing—Failed to provide a safe medication administration system
04 Apr 2014Inspection
04 Apr 2014Inspection
Investigated an allegation that medication was not administered as ordered and found a deficiency in medication administration with minor harm potential.
Licensing—Failed to administer medication as ordered
24 Mar 2014Inspection
24 Mar 2014Inspection
Investigated and found care related to falls was inadequate.
Licensing—Failed to adequately care plan related to falls
04 Oct 2013Abuse: Financial abuse
04 Oct 2013Abuse: Financial abuse
Investigated a complaint about an unsafe environment and financial abuse; found a resident was not protected from theft, and a $300 fine was assessed.
Abuse—Failed to provide safe environment
05 Sept 2013Abuse: Financial abuse
05 Sept 2013Abuse: Financial abuse
Investigated a complaint and found a failure to protect the Reported Victims from theft.
Abuse—Failed to provide safe environment
05 Sept 2013Abuse: Financial abuse
05 Sept 2013Abuse: Financial abuse
Investigated an allegation of unsafe environment and found that a resident's personal belongings were not protected from theft.
Abuse—Failed to provide safe environment
01 Sept 2013Abuse: Financial abuse
01 Sept 2013Abuse: Financial abuse
Investigated an allegation of financial abuse and found a failure to protect residents from theft.
Abuse—Failed to provide safe environment
29 Jul 2013Abuse: Neglect
29 Jul 2013Abuse: Neglect
Investigated an abuse/neglect allegation related to falls and found that a safe environment was not maintained.
Abuse—Failed to adequately care plan related to falls
27 Jun 2013Abuse: Financial abuse
27 Jun 2013Abuse: Financial abuse
Investigated and found a failure to provide a secure environment.
Abuse—Failed to provide safe environment
26 Jun 2013Abuse: Financial abuse
26 Jun 2013Abuse: Financial abuse
Investigated a complaint and found a failure to protect a resident from theft.
Abuse—Failed to provide safe environment
28 Apr 2013Inspection
28 Apr 2013Inspection
Found failure to administer medication as ordered.
Licensing—Failed to administer medication as ordered
11 Jan 2013Inspection
11 Jan 2013Inspection
Investigated and identified a licensing violation involving failure to administer medication as ordered and a deficiency in providing a safe environment.
Licensing—Failed to administer medication as ordered
27 Nov 2012Inspection
27 Nov 2012Inspection
Identified deficiencies in the medication administration system. The findings show it was not adequately maintained.
Licensing—Failed to provide a safe medication administration system
10 Oct 2012Abuse: Financial abuse
10 Oct 2012Abuse: Financial abuse
Investigated a financial abuse allegation and found failures to report potential or suspected abuse, to conduct an internal investigation, and to contact Adult Protective Services.
Abuse—Failed to report potential or suspected abuse
29 Jul 2012Abuse: Neglect
29 Jul 2012Abuse: Neglect
Identified deficiencies related to maintaining a door alarm or call system and providing appropriate care to a resident.
Abuse—Failed to maintain functional door alarm or call system
16 Jun 2012Abuse: Neglect
16 Jun 2012Abuse: Neglect
Investigated an allegation of neglect related to medication administration and found a safety-system deficiency; a fine was assessed.
Abuse—Failed to administer medication as ordered
29 May 2012Inspection
29 May 2012Inspection
Found an inadequate medication administration system.
Licensing—Failed to provide a safe medication administration system
23 Oct 2011Abuse: Neglect
23 Oct 2011Abuse: Neglect
Found a failure to maintain a safe medication administration system. This indicates issues with medication safety.
Abuse—Failed to provide a safe medication administration system
14 Mar 2011Inspection
14 Mar 2011Inspection
Investigated and found an inadequate medication system. The medication administration allegation was substantiated.
Licensing—Failed to administer medication as ordered
10 Nov 2010Inspection
10 Nov 2010Inspection
Investigated a complaint and found a failure to answer a call light in a timely manner, indicating deficient care.
Licensing—Failed to answer call light in a timely manner
07 May 2010Abuse: Neglect
07 May 2010Abuse: Neglect
Found deficiencies in care due to failure to intervene when a resident's condition changed.
Abuse—Failed to intervene when resident's condition changed
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