Powell Valley Assisted Living and Memory Care

    4001 SE 182nd Ave, Gresham, OR 97030
    • Assisted Living
    • Memory Care

    Immaculate facility, compassionate staff, recommended

    I placed my mom here and I'm very pleased. The facility is immaculate with beautiful grounds, the staff are compassionate, attentive and professional, and the activities and meals are varied and engaging. Communication is good, move-in was smooth, and I'd wholeheartedly recommend this community to other families.

    Loved one of 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

    • 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

    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

    3.92·(83)

    Overall rating

    1. 5
    2. 4
    3. 3
    4. 2
    5. 1
    • Care

      3.7
    • Staff

      4.0
    • Meals

      3.7
    • Amenities

      3.7
    • Value

      2.8

    Pros

    • clean, well-maintained facility
    • landscaped grounds and attractive gardens
    • recently remodeled apartments and updated fixtures
    • secure memory-care environment
    • private apartments with ability to personalize
    • in-unit or on-floor washer/dryer access
    • weekly housekeeping and linen service
    • dependable transportation and field-trip program
    • robust activities program including music therapy and outings
    • library, rec rooms, and common social spaces
    • on-site beauty/barber services
    • attentive and compassionate direct-care staff
    • strong front-desk and customer-service presence
    • 24/7 availability or responsiveness to families
    • flexible meal times and varied menu options
    • nutritious meal selections including vegetarian options
    • well-kept, odor-free interior and common areas
    • modern, comfortable common-room spaces
    • accepts Medicaid

    Cons

    • inconsistent medication administration and tracking
    • high staff turnover and uneven training
    • understaffing during evenings and some shifts
    • gaps in family communication and clinical coordination
    • inconsistent meal quality and presentation
    • supply-provisioning gaps for toiletries and linens
    • security and personal-item safety concerns
    • variable cleanliness and upkeep in memory-care units
    • pricing opacity and perceived high monthly costs
    • inconsistent infection-control practices and notification
    • uneven responsiveness to medical emergencies
    • uneven activity programming in memory-care versus assisted living

    Summary of reviews

    Overall impression: Reviews show a polarized picture. Many families and residents praise Powell Valley for its clean, modern campus, landscaped grounds, and a wide range of social and recreational programming. At the same time, there are recurring operational concerns that have materially affected some residents’ experiences. Prospective residents should weigh the facility’s physical environment and activity offerings against the reported variability in clinical and operational consistency.

    Care and staff: Staffing is a clear strength and a recurring pain point. Numerous accounts describe compassionate, hands-on caregivers, an engaged front desk, and staff who foster resident engagement and dignity. These positive accounts emphasize personalized attention, calm interactions, and staff who help residents regain confidence and routines. Counterbalancing that, there are multiple accounts of high turnover, variability in staff training and professionalism, understaffing on certain shifts, and lapses in timeliness of care. The net picture is mixed: when staffing is stable and experienced, families describe very good outcomes; when turnover or shortages occur, families report slower responses and inconsistent care.

    Clinical operations and safety: Medication administration and clinical coordination emerge as one of the most significant operational concerns. Reviews cite delays, missed doses, and tracking problems that indicate gaps in medication-administration processes and oversight. There are also concerns about communication with external clinicians and hospice providers and instances where family notification and clinical follow-up were perceived as insufficient. Additionally, there are allegations of missing personal items; these raise security and personal-item safety questions that families will want to address directly with management and during tours.

    Dining and supplies: Dining experiences are uneven across reviews. Many residents praise the menu variety, healthy options, good portions, vegetarian choices, and appealing presentation. Other accounts describe fluctuating food quality and occasions when meals were not appetizing. Separately, there are recurring notes about supply shortfalls — families have reported having to provide basic toiletries or towels — suggesting a breakdown in routine provisioning for some residents.

    Activities and social life: Activity programming is a consistent strength. Reviews highlight a wide array of offerings: music therapy, live entertainment, exercise classes, reading groups, field trips, and seasonal events. The facility’s transportation and outing schedules are frequently praised, and common spaces such as the library, rec rooms, and courtyard support social engagement. That said, some reviewers described the memory-care activity schedule as limited or institutional in feel, so activity availability may differ by unit or care level.

    Facilities and environment: Physical plant advantages are consistently noted: recently remodeled units, corner apartments with more light, walk-in showers, small patios, and well-maintained landscaping. Common areas are often described as clean and inviting, and the facility offers amenities such as on-site beauty services and laundry access. Memory-care units were described both as a core strength (specialized programming and patterned walls to aid recognition) and, in other accounts, as older or less updated than assisted-living areas.

    Management and policy patterns: Reviewers raise concerns about management consistency, fee transparency, and contract clarity. Pricing is frequently described as high relative to local options, and some families question billing for services not received. Infection-control and outbreak management were called out in a few accounts as problematic, particularly in notification and disinfection practices. There are also reports of state-level attention in at least one instance. These systemic issues suggest that prospective families should inquire specifically about staffing ratios, medication-safety protocols, infection-control policies, and how billing disputes are resolved.

    Notable patterns and guidance: The facility tends to elicit strong positive or negative reactions rather than middling ones. When staff continuity, credentialing, and management oversight are present, families describe an excellent, compassionate community; when those operational supports waver, concerns cluster around medication safety, communication, and supply/security processes. Visitors should schedule tours at different times of day, ask for details on medication-administration procedures, staffing ratios by shift, toiletry/linen policies, infection-control protocols, activity schedules for the specific care level of interest, and a clear explanation of fee structure and grievance procedures.

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    Location

    Map showing location of Powell Valley Assisted Living and Memory Care

    Powell Valley Assisted Living and Memory Care is located at 4001 SE 182nd Ave, Gresham, OR, 97030.

    About Powell Valley Assisted Living and Memory Care

    Powell Valley Assisted Living and Memory Care sits at 4001 SE 182nd Avenue in Gresham and offers a lot of options for seniors who need different levels of care, and it's the kind of place where you'll see staff helping with things like bathing, dressing, medication reminders, and just getting from place to place, whether it's to activities or the dining room, and if someone's not feeling well there's food delivered right to the apartment and help with medication management, even with ordering and storing prescriptions, and folks who need temporary support or are coming back from surgery can get respite care so the family gets a little break and the resident gets professional help, and the place is known for helping people through memory loss, Alzheimer's, and dementia with secure memory care areas and programs to help keep cognitive function up, and they really focus on keeping folks active with full schedules of activities, social groups, outings for groceries or medical appointments with transportation all arranged, and a friendly approach that respects each person's individuality and history.

    The building features indoor and outdoor common areas, including gardens, a gazebo, a small pond, and places to sit in the fresh air, and the different apartments-studios, suites, one-bedrooms, and two-bedrooms-give people a choice in how they want to live, and yes, pets are welcome, because they know how much comfort an animal can bring. People who use wheelchairs can get showers easily, and residents get daily help with laundry, cleaning, towels, linens, and trash, so no one has to worry about the little chores that can pile up. There's also special support for folks needing a little more help getting around or transferring from place to place, including escorts, and all meal services have help for those who need food cut up, food prepared in a certain way, and when folks are ill, trays can go straight to the apartments.

    Powell Valley has a family-feel philosophy rooted in the old family farm and rose garden that used to be there, and they do keep up a tradition of treating people as individuals, making sure everyone feels respected and included. They work with Village HealthCare nearby so people who need skilled nursing or rehab have options, making it pretty easy to get help whatever your needs. There's an onsite beautician for haircuts, devotional services both in and out of the building, and no smoking indoors, ever. The memory care team is noted for their activities, engaging folks with programs that help with socialization, friendship, and keeping minds as sharp as possible, and staff are there all day and all night, every day, so people never have to feel alone or go without help if they need it, and the philosophy really centers on letting people age at their own pace, blending independence with as much support as makes sense, so there isn't any pressure to give up independence before it's truly needed.

    The community does have daily tours, and folks who want to look around or need a virtual tour can set one up, so families who aren't sure what's best for their loved ones can come see the place, look at the range of suites, check out the activities and common areas, and talk to someone like Deanndrea Gonzalez, the marketing director, if they want to know more about daily life. There's resident parking, transportation services, a pet-friendly policy, and the staff are known for helping families find the fit that works best for each person as needs change. Powell Valley tries to create a setting where people feel safe, valued, and able to make the most of their days, and the support is there if someone starts to need more help. The quiet grounds, the community's history, and its range of activities make it a spot where seniors can live comfortably and stay as independent as they can for as long as possible.

    People often ask...

    Powell Valley Assisted Living and Memory Care offers competitive pricing, with rates starting at a cost of $6,309 per month.

    Powell Valley Assisted Living and Memory Care offers assisted living and memory care.

    There are 20 photos of Powell Valley Assisted Living and Memory Care on Mirador.

    The full address for this community is 4001 SE 182nd Ave, Gresham, OR 97030.

    No, Powell Valley Assisted Living and Memory Care 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.

    License number5MA213
    StatusActive
    Facility typeResidential Care Facility
    Capacity42 residents
    LicenseeW2 Powell Valley, LLC
    EffectiveAugust 30th, 1998
    Special certificationMemory Care
    View the official license record

    Inspection Reports

    102

    Reports

    0

    Type A Citations

    0

    Type B Citations

    2

    Complaints

    16

    Years

    08 Jul 2026License Condition
    Found insufficient direct care staffing to meet residents' 24-hour needs and cited staffing requirement violations.
    • Regulatory ActionFailed to use an ABST
    26 Mar 2026Licensure
    Investigated found multiple deficiencies across reporting abuse, resident evaluations and service plans, health services, medication management, staffing, and fire safety.
    • DeficiencyReporting & Investigating Abuse-Other Action
    • DeficiencyResident Move-in & Evaluation: Res Evaluation
    • DeficiencyService Plan: General
    • DeficiencyChange of Condition and Monitoring
    • DeficiencyResident Health Services
    • DeficiencySystems: Tracking Control Substances
    • DeficiencySystems: Resident Right to Refuse
    • DeficiencySystems: Medication Administration
    • DeficiencySystems: Psychotropic Medication
    • DeficiencyAcuity Based Staffing Tool - ABST Time
    • DeficiencyAcuity Based Staffing Tool - Updates & Staffing Plan
    • DeficiencyFire and Life Safety: Safety
    02 Mar 2026Inspection
    Investigated a care provision allegation and found a staff member failed to provide safe environment and appropriate care, resulting in harm.
    • LicensingFailed to provide safe environment
    02 Jan 2026Inspection
    Identified that the ABST did not accurately reflect residents' needs and required ADLs, with inconsistencies between rosters, care plans, and ABST data, and staffing not aligned with needs.
    • LicensingFailed to use an ABST
    02 Jan 2026Inspection
    Found that an updated Acuity-Based Staffing Tool reflecting resident population and care needs was not in place, with inconsistencies between the roster, care plans, and ABST data.
    • LicensingFailed to use an ABST
    25 Sept 2025Kitchen
    Found deficiencies in meals/food sanitation and administration compliance, with extensive kitchen cleanliness, storage, and repair issues identified.
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyAdministration Compliance
    25 Sept 2025Kitchen
    Identified deficiencies in kitchen sanitation and food storage, including dirty surfaces, damaged equipment, and improper temperatures. Noted improper staff practices and unclean conditions.
    • DeficiencyResident Services Meals, Food Sanitation Rule
    25 Aug 2025Inspection
    Determined that records were not provided to the Department upon request by the due date.
    • LicensingFailed to provide safe environment
    23 Aug 2025Inspection
    Determined that a medication administration error occurred, with morphine administered to the wrong resident and no active morphine order for that resident.
    • LicensingFailed to provide a safe medication administration system
    08 Aug 2025License Condition
    Identified deficiencies in implementing and updating an acuity-based staffing tool and in staffing levels.
    • Regulatory ActionFailed to use an ABST
    05 Aug 2025Abuse: Neglect
    Found abuse by neglect due to failure to follow the care plan, resulting in difficulty participating and loss of personal dignity.
    • AbuseFailed to follow care plan
    02 Jul 2025License Condition
    Found out-of-compliance with multiple Oregon Administrative Rules due to unsafe environment. Twenty-one violations were identified, including two at harm.
    • Regulatory ActionFailed to provide safe environment
    23 May 2025Licensure
    Investigated found widespread deficiencies affecting resident rights, privacy, move-in and quarterly evaluations, service plans, health care, infection control, abuse reporting, staffing, fire safety, and activities.
    • DeficiencyResident Rights and Protection - General
    • DeficiencyReporting & Investigating Abuse-Other Action
    • DeficiencyResident Move-in & Evaluation: Res Evaluation
    • DeficiencyService Plan: General
    • DeficiencyChange of Condition and Monitoring
    • DeficiencyResident Health Services
    • DeficiencyInfection Prevention & Control
    • DeficiencySystems: Treatment Orders
    • DeficiencySystems: Resident Right to Refuse
    • DeficiencyAcuity Based Staffing Tool - Updates & Staffing Plan
    • DeficiencyFire and Life Safety: Safety
    • DeficiencyFire and Life Safety: Training for Residents
    • DeficiencyIndividual Rights Settings: Privacy, Dignity
    • DeficiencyPhysical Setting: Individual Accessible
    • DeficiencyIndividual Privacy: Own Unit
    • DeficiencyIndividual Door Locks: Key Access
    • DeficiencyAdministration Compliance
    • DeficiencyStaff Training Requirements
    • DeficiencyCompliance with Rules Health Care
    • DeficiencyNutrition and Hydration
    • DeficiencyActivities
    24 Apr 2025Licensure
    Investigated multiple deficiencies across records, service planning, change of condition monitoring, health services coordination, infection control, medication administration, staffing, training, and facility maintenance. Altered documentation was found for some residents.
    • DeficiencyFacility Administration: Records
    • DeficiencyService Plan: General
    • DeficiencyChange of Condition and Monitoring
    • DeficiencyResident Health Services
    • DeficiencyRes Hlth Srvc: On- and Off-Site Health Srvc
    • DeficiencyInfection Prevention & Control
    • DeficiencySystems: Medication Administration
    • DeficiencyAcuity Based Staffing Tool - ABST Time
    • DeficiencyAcuity Based Staffing Tool - Updates & Staffing Plan
    • DeficiencyTraining Within 30 Days of Hire – Direct Care Staff
    • DeficiencyAnnual and Biennial Inservice for All Staff
    • DeficiencyFire and Life Safety: Training for Residents
    • DeficiencyInspections and Investigation: Insp Interval
    • DeficiencyGeneral Building Exterior
    • DeficiencyGeneral Building: Doors-Walls, Cleanable
    • DeficiencyHeating and Ventilation
    25 Mar 2025Inspection
    Investigated found the acuity-based staffing tool was not developed or kept current, and staffing plans did not reflect resident needs, resulting in shortages.
    • LicensingFailed to use an ABST
    12 Nov 2024Inspection
    Found deficiencies in maintaining and using an acuity-based staffing tool, resulting in understaffing and misaligned staffing plans across shifts.
    • LicensingFailed to use an ABST
    31 Oct 2024Inspection
    Identified deficiencies in acuity-based staffing tool use and staffing planning, including missing care time entries, outdated ABST evaluations, and misalignment with resident needs.
    • LicensingFailed to use an ABST
    31 Oct 2024Abuse: Neglect
    Found violations for neglect and abuse due to failure to implement protective interventions for a resident with a known behavioral history, resulting in emotional harm to another resident; a $500 fine was assessed.
    • AbuseFailed to provide safe environment
    29 Oct 2024Kitchen
    Identified deficiencies in kitchen cleanliness and food sanitation, with multiple areas needing cleaning and maintenance.
    • DeficiencyResident Services Meals, Food Sanitation Rule
    29 Oct 2024Kitchen
    Identified deficiencies in kitchen sanitation practices and administration compliance.
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyAdministration Compliance
    27 Sept 2024Abuse: Neglect
    Found failures to plan care and provide adequate fall interventions for a resident with a known fall history, resulting in an unwitnessed fall and a right hip fracture with severe pain. A $1,500 penalty was assessed.
    • AbuseFailed to properly plan care
    14 Jun 2024Abuse: Neglect
    Investigated a wandering and disorientation incident and found neglect due to failure to properly plan care to mitigate risk.
    • AbuseFailed to properly plan care
    11 Mar 2024Abuse: Neglect
    Found a lapse in supervision that allowed a resident to elope by bypassing two secured doors, placing them at risk of harm.
    • AbuseFailed to provide safe environment
    03 Jan 2024Inspection
    Found a violation of safe medication administration practices after discovering tampered narcotic cards and eight diverted pills; no medications were missed and no tainted medication was administered.
    • LicensingFailed to provide a safe medication administration system
    03 Jan 2024Inspection
    Found a failure to provide a safe medication administration system after narcotics were tampered with and diverted.
    • LicensingFailed to provide a safe medication administration system
    23 Dec 2023Inspection
    Investigated and concluded that a resident was financially exploited and that the provider failed to protect the resident from financial exploitation.
    • LicensingFailed to provide safe environment
    16 Dec 2023Inspection
    Investigated an allegation that a resident was not protected from financial exploitation. A wedding ring disappeared and an unknown person took it, indicating neglect and financial abuse.
    • LicensingFailed to protect resident from financial exploitation
    15 Dec 2023Inspection
    Investigated a financial exploitation incident and found an unsafe environment contributing to the exploitation.
    • LicensingFailed to provide safe environment
    04 Dec 2023Complaint
    Found deficiencies in updating care plans after significant changes, ongoing medication management problems, insufficient staffing, and incomplete use of an acuity-based staffing tool.
    • DeficiencyLicensing Complaint Investigation
    • DeficiencyChange of Condition and Monitoring
    • DeficiencySystems: Medications and Treatments
    • DeficiencySystems: Treatment Orders
    • DeficiencyStaffing Requirements and Training: Staffing
    • DeficiencyAcuity-Based Staffing Tool
    02 Nov 2023Abuse: Neglect
    Found a failure to provide a safe medication administration system, resulting in elevated blood pressure and emotional distress, constituting abuse.
    • AbuseFailed to provide a safe medication administration system
    02 Aug 2023Licensure
    Identified deficiencies related to kitchen sanitation practices on 08/02/23, including dishwasher status, uncovered garbage cans, greasy vents, improper glove use, and lack of hair restraints. Follow-up confirmed substantial compliance with applicable rules.
    • DeficiencyComment
    • DeficiencyResident Services Meals, Food Sanitation Rule
    02 Aug 2023Licensure
    Found deficiencies in kitchen sanitation practices and administration compliance during two visits. Subsequent follow-up concluded substantial compliance.
    • DeficiencyComment
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyAdministration Compliance
    15 Jun 2023Complaint
    Investigated and found deficiencies in evaluating a resident's health and care needs after discharge readiness and in issuing a move-out notice.
    • DeficiencyLicensing Complaint Investigation
    • DeficiencyInvoluntary Move-Out Criteria
    05 Jun 2023Inspection
    Investigated the allegation of medication not administered as ordered; determined that medication and treatment orders were not carried out as prescribed.
    • LicensingFailed to administer medication as ordered
    12 May 2023Inspection
    Investigated the allegation of failing to administer medication as ordered and determined noncompliance with medication orders.
    • LicensingFailed to administer medication as ordered
    02 May 2023Inspection
    Found a violation for failing to carry out medication and treatment orders.
    • LicensingFailed to provide medical treatment as ordered
    29 Mar 2023Inspection
    Found that pain medications were not administered as ordered, causing unnecessary discomfort and indicating neglect, abuse, and an unsafe medication administration system.
    • LicensingFailed to provide a safe medication administration system
    14 Mar 2023Inspection
    Found a resident's pain medication stolen and failure to protect from theft, constituting abuse and financial exploitation.
    • LicensingFailed to provide safe environment
    20 Jan 2023Abuse: Neglect
    Investigated a neglect allegation about leaving a resident unattended in the shower and found training gaps on the resident's care plan that placed the resident at risk. A $500 fine was assessed.
    • AbuseFailed to follow care plan
    29 Dec 2022Inspection
    Investigated a fall incident and found that staff did not assess after the fall and the environment was unsafe, resulting in injuries and abuse.
    • LicensingFailed to provide safe environment
    19 Dec 2022Inspection
    Identified insufficient direct care staff to meet residents' scheduled and unscheduled needs.
    • LicensingFailed to meet the scheduled and unscheduled needs of residents
    19 Dec 2022Inspection
    Found a deficiency in oversight and monitoring of significant changes in condition, including failure to evaluate, refer to a nurse, document the change, and update the service plan as needed.
    • LicensingFailed to provide oversight and monitoring of change of condition
    27 Oct 2022Abuse: Neglect
    Found inadequate supervision that allowed a resident to elope from a secured area, creating risk of harm. This indicates a failure to provide a safe environment.
    • AbuseFailed to provide safe environment
    02 Oct 2022Abuse: Neglect
    Found failure to provide a safe environment leading to multiple resident altercations; a $500 fine was assessed.
    • AbuseFailed to provide safe environment
    30 Sept 2022Abuse: Neglect
    Found that inadequate interventions and monitoring of a resident's known behavior led to a resident-to-resident altercation and neglect/abuse. A fine was assessed.
    • AbuseFailed to provide safe environment
    30 Sept 2022Inspection
    Investigated a complaint and determined that a resident's health and care needs were not evaluated within 24 hours after the resident was deemed ready for discharge.
    • LicensingFailed to provide safe environment
    30 Sept 2022Abuse: Neglect
    Investigated allegations of inadequate safety and resident monitoring; found that interventions were not implemented and supervision was insufficient, leading to a resident-to-resident altercation and discomfort for the victim.
    • AbuseFailed to provide safe environment
    28 Sept 2022Abuse: Neglect
    Investigated a medication safety issue and found a failure to provide a safe medication administration system, resulting in patient discomfort and neglect.
    • AbuseFailed to provide a safe medication administration system
    25 Sept 2022Abuse: Neglect
    Determined that abuse and neglect occurred when a resident was harmed by another resident and staff did not redirect the aggressor, resulting in a $500 fine.
    • AbuseFailed to provide safe environment
    24 Sept 2022Inspection
    Found a licensing violation due to inadequate professional oversight of the medication and treatment administration system.
    • LicensingFailed to provide safe environment
    22 Sept 2022Inspection
    Investigated found that the ABST was not updated to reflect resident needs, causing inconsistencies among the roster, care plans, posted staffing plan, and ABST data.
    • LicensingFailed to use an ABST
    22 Sept 2022Inspection
    Found insufficient direct care staff to meet scheduled and unscheduled resident needs, resulting in delays in responding to alert pendants.
    • LicensingFailed to answer call light in a timely manner
    03 Jun 2022Abuse: Neglect
    Investigated a complaint and found that inadequate supervision allowed a resident to elope from the secured building, risking harm and constituting neglect and abuse.
    • AbuseFailed to provide safe environment
    04 Apr 2022Validation
    Identified numerous deficiencies across service plans, medication management, resident rights, staff training, safety, and facility maintenance, with a substantial compliance finding noted on the follow-up visit for licensure requirements.
    • DeficiencyComment
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyService Plan: General
    • DeficiencyChange of Condition and Monitoring
    • DeficiencyRn Delegation and Teaching
    • DeficiencySystems: Treatment Orders
    • DeficiencySystems: Resident Right to Refuse
    • DeficiencySystems: Medication Administration
    • DeficiencyRestraints and Supportive Devices
    • DeficiencyTraining Within 30 Days: Direct Care Staff
    • DeficiencyAnnual and Biennial Inservice For All Staff
    • DeficiencyFire and Life Safety: Safety
    • DeficiencyFire and Life Safety: Training For Residents
    • DeficiencyInspections and Investigation: Insp Interval
    • DeficiencyGeneral Building: Doors-Walls, Cleanable
    04 Apr 2022Validation
    Identified multiple deficiencies across kitchen sanitation, resident health services, staff training, fire safety, administration, and activities during the re-licensure process; the final revisit noted substantial compliance.
    • DeficiencyComment
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyChange of Condition and Monitoring
    • DeficiencyResident Health Services
    • DeficiencyTraining Within 30 Days: Direct Care Staff
    • DeficiencyFire and Life Safety: Safety
    • DeficiencyFire and Life Safety: Training For Residents
    • DeficiencyAdministration Compliance
    • DeficiencyStaff Training Requirements
    • DeficiencyCompliance With Rules Health Care
    • DeficiencyActivities
    18 Nov 2021Abuse: Neglect
    Investigated the complaint and found neglect and abuse due to lack of oversight of a resident's change in condition, causing health decline, pressure sores, and weight loss. A $1500 fine was assessed.
    • AbuseFailed to provide oversight and monitoring of change of condition
    17 Oct 2021Inspection
    Investigated a care plan noncompliance and safety lapse; found neglect of care and an unsafe environment due to not following the care plan.
    • LicensingFailed to provide safe environment
    29 Sept 2021Abuse: Neglect
    Found that care services were not provided as described in the resident's care plan, causing discomfort and violating rights. A $250 fine was assessed.
    • AbuseFailed to follow care plan
    05 Jan 2021Inspection
    Investigated the allegation of failing to provide infection control and found a deficiency involving inadequate precautions that may threaten residents' health and safety.
    • LicensingFailed to provide infection control
    05 Jan 2021Inspection
    Investigated the allegation of failure to assist with dressing or grooming and identified a deficiency in implementing services.
    • LicensingFailed to assist with dressing or grooming
    05 Jan 2021Inspection
    Investigated a complaint and found there were no policies and procedures to prevent and respond to incidents, including falls not properly documented.
    • LicensingFailed to assure resident was safe
    09 Jul 2020Abuse: Neglect
    Identified a safety deficiency when an exit-seeking resident left through an unsecured gate, putting the resident at risk and resulting in an abuse/neglect finding.
    • AbuseFailed to provide safe environment
    04 Jun 2020Inspection
    Determined that a staff member administered another resident's medications to a resident, causing medical harm, and found neglect and abuse with a failure to protect residents from staff actions.
    • LicensingFailed to provide a safe medication administration system
    21 Mar 2020Abuse: Neglect
    Found that a resident was physically abused by staff, left on the floor for over an hour without monitoring, and not protected from abuse, resulting in a $450 fine.
    • AbuseFailed to protect resident from physical abuse
    21 Mar 2020Abuse: Neglect
    Investigated an allegation of neglect and abuse; staff refused to assist a resident, leaving them on the floor for over an hour without monitoring.
    • AbuseFailed to assist with ambulation or mobility
    21 Mar 2020Abuse: Neglect
    Investigated abuse and neglect; found that staff failed to monitor a resident and allowed verbal abuse, leaving the resident on the floor unattended for about 1 hour and 21 minutes.
    • AbuseFailed to protect resident from verbal abuse
    04 Oct 2019Abuse: Neglect
    Determined that a defective call button and unresponsive staff resulted in neglect and abuse related to the call-light system.
    • AbuseFailed to answer call light in a timely manner
    11 Jul 2019Inspection
    Found that suspected abuse was not reported; a $1,000 fine was assessed.
    • LicensingFailed to report potential or suspected abuse
    11 Jul 2019Abuse: Neglect
    Found neglect for failing to provide a safe environment, resulting in a fall with injury; a $1500 fine was assessed.
    • AbuseFailed to provide safe environment
    13 May 2019Abuse: Neglect
    Found neglect for failing to administer medications as ordered, which caused breathing difficulty. A $250 fine was assessed.
    • AbuseFailed to provide a safe medication administration system
    13 May 2019Inspection
    Investigated an allegation of failing to report suspected abuse; found a violation and a $750 fine was assessed.
    • LicensingFailed to report potential or suspected abuse
    16 Mar 2019Abuse: Neglect
    Identified neglect that posed risk of serious harm and assessed a fine. The finding related to failure to provide basic care.
    • AbuseFailed to properly plan care
    11 Jan 2019Inspection
    Investigated an allegation of not providing a safe environment and found a failure to maintain substantial compliance.
    • LicensingFailed to provide safe environment
    16 Nov 2018Abuse: Neglect
    Investigated the neglect allegation and concluded that necessary care was not provided, which led to a skin tear.
    • AbuseFailed to follow care plan
    01 May 2018Inspection
    Concluded that the provider failed to provide or maintain resident care equipment.
    • LicensingFailed to provide or maintain resident care equipment
    01 May 2018Inspection
    Investigated the staffing allegation and substantiated the finding that appropriate staffing was not provided
    • LicensingFailed to provide appropriate staffing
    01 May 2018Inspection
    Determined that the allegation of failing to provide a safe environment was substantiated.
    • LicensingFailed to provide safe environment
    13 Mar 2018Abuse: Financial abuse
    Found a safety deficiency involving failure to protect the reported victim from theft, and assessed a fine of $1,125.00.
    • AbuseFailed to provide safe environment
    09 Mar 2018Abuse: Financial abuse
    Determined that financial abuse occurred and a resident was not protected from theft of medication.
    • AbuseFailed to protect resident from financial exploitation
    19 Jun 2017Inspection
    Determined that a medication administration failure occurred as alleged.
    • LicensingFailed to administer medication as ordered
    19 Jun 2017Inspection
    Investigated the allegation of financial exploitation and found a violation for failing to protect a resident from financial exploitation.
    • LicensingFailed to protect resident from financial exploitation
    17 Jan 2017Inspection
    Concluded there was a deficiency in the medication administration system when one ordered medication was not administered.
    • LicensingFailed to provide a safe medication administration system
    13 Jul 2016Inspection
    Found failure to maintain an adequate medication system that supports safe medication administration.
    • LicensingFailed to provide a safe medication administration system
    28 Dec 2015Inspection
    Determined that there was a deficiency in safe medication administration, with the reported medication not administered as ordered.
    • LicensingFailed to provide a safe medication administration system
    28 Sept 2015Inspection
    Investigated and found the care plan for the reported Victim was not followed, with potential for moderate harm.
    • LicensingFailed to follow care plan
    03 May 2015Abuse: Financial abuse
    Investigated an allegation of financial abuse and found a lack of a secure environment.
    • AbuseFailed to provide safe environment
    15 Dec 2014Abuse: Financial abuse
    Investigated a financial abuse allegation and found a resident was not protected from loss of property.
    • AbuseFailed to provide safe environment
    28 Sept 2013Abuse: Neglect
    Found a failure to provide a safe medication administration system.
    • AbuseFailed to provide a safe medication administration system
    16 Jan 2013Abuse: Neglect
    Investigated an allegation of failing to obtain a medical order and found that appropriate care was not provided.
    • AbuseFailed to obtain medical order
    08 Sept 2012Abuse: Neglect
    Investigated the allegation and found the physician's orders for medical treatment were not followed.
    • AbuseFailed to provide medical treatment as ordered
    20 Aug 2012Inspection
    Determined that there was inadequate screening or assessment and failure to intervene.
    • LicensingFailed to perform adequate screening or assessment
    18 Aug 2012Inspection
    Found that resident rights were not protected due to inappropriate actions toward a resident.
    • LicensingFailed to assure resident rights
    28 Nov 2011Abuse: Neglect
    Determined that a safe medication system was not maintained.
    • AbuseFailed to provide a safe medication administration system
    23 Dec 2010Inspection
    Found failure to thoroughly investigate a possible theft and to report the allegation to Adult Protective Services.
    • LicensingFailed to report potential or suspected abuse
    20 Dec 2010Inspection
    Found that an adequate medication system was not maintained and medication was not available.
    • LicensingFailed to have medication available
    19 Dec 2010Inspection
    Investigated the allegation that staff failed to address a resident's behavior and found a safety deficiency related to RV1.
    • LicensingFailed to address resident's behavior
    07 Dec 2010Inspection
    Determined that an internal investigation into aggression and unwitnessed falls was not completed.
    • LicensingFailed to investigate injury of unknown origin to rule out abuse
    07 Dec 2010Inspection
    Investigated a claim of failing to report potential or suspected abuse and identified a reporting deficiency.
    • LicensingFailed to report potential or suspected abuse
    07 Dec 2010Inspection
    Found failure to care plan for aggression and falls.
    • LicensingFailed to properly plan care
    07 Dec 2010Inspection
    Investigated an allegation of failing to provide a safe environment and found a resident was not protected from another resident.
    • LicensingFailed to provide safe environment
    28 Oct 2010Abuse: Neglect
    Investigated the neglect allegation and determined the issue to be substantiated; a civil penalty was assessed.
    • AbuseFailed to provide oversight and monitoring of change of condition
    18 Feb 2010Abuse: Neglect
    Investigated an allegation of neglect and found that the care plan did not follow the assessment and medical advice was not sought promptly.
    • AbuseFailed to care plan in accordance with assessment

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