I placed my mother in their memory care and have been very pleased - compassionate, calm staff, engaged leadership, and clear, regular communication made the move easy. Her clean, brand-new apartment (large room, stainless kitchen, balcony), three meals a day, transportation, and lively activities - even an exhilarating water outing - kept her happy and well cared for. The social worker and caregivers show genuine interest, and the community feels warm, family-like.
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
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
3.12·(33)
Overall rating
5
4
3
2
1
Care
3.1
Staff
3.3
Meals
2.2
Amenities
3.0
Value
2.0
Pros
Friendly and engaging management
Compassionate and attentive caregivers
Brand-new apartments with balconies and airport view
Dog-friendly accommodations
Full kitchens with stainless-steel appliances
Three meals per day provided
Transportation for shopping, medical appointments, and planned outings
Large rooms with walk-in bathtub options
Active resident community and collegial atmosphere
On-site laundry facilities
Strong social-work and care-coordination support
Long-tenured and family-like staff relationships
Cons
Inconsistent staffing levels and high turnover
Variable caregiver training and competency
Gaps in responsiveness and resident monitoring
Weak medication-administration controls
Laundry and personal-property management lapses
Inconsistent meal quality and limited fresh-vegetable options
Sanitation and cleanliness issues in certain areas
Maintenance shortcomings affecting heating, AC, and flooring safety
Limited multilingual communication and Spanish-language support
Restricted third-party service flexibility (mandatory provider requirements)
Inadequate family communication and incident follow-up
Allegations of theft and property-security weaknesses
Activity and outing access limitations
Family-operated governance with favoritism concerns
Summary of reviews
The reviews describe a facility with clear strengths in its physical accommodations and pockets of high-quality, person-centered care, coupled with recurring operational weaknesses. Positive remarks emphasize newly built apartment units, balconies with an airport view, stainless-steel kitchens, walk-in bathtubs, on-site laundry, and dog-friendly policies. Several comments highlight engaged and compassionate staff members, strong social-work support, a welcoming resident community, and available transportation and meal service. For many families the environment and some long-tenured staff contribute to a comfortable, family-like atmosphere.
However, a number of recurring operational issues appear across reviews. Staffing is uneven: reviewers cite high turnover, inconsistent shift coverage, and variability in caregiver training and competency. Those staffing problems coincide with gaps in responsiveness and resident monitoring, creating concerns about timely assistance, medication administration protocols, and follow-up after clinical or end-of-life events. State inspection references and family descriptions point to weaknesses in clinical processes that merit management attention.
Dining and housekeeping receive mixed feedback. While the facility provides three meals daily, several reviewers describe inconsistent food quality, overcooked items, limited fresh-vegetable options, and lapses in basic food-safety practices. Cleanliness and sanitation are described positively by some families but negatively by others; comments reference room- and common-area sanitation issues, laundry problems, and personal-property mismanagement such as missing clothing or rummaged drawers, indicating inconsistent housekeeping and inventory controls.
Facility maintenance and safety are other notable patterns. Some reviewers praise the new construction and cleanliness, while others report maintenance shortcomings including heating/AC reliability problems and unsecured or slippery flooring that pose near-fall risks. These physical-safety concerns are operational in nature and suggest the need for prioritized maintenance and environmental-risk mitigation.
Communication and culture also show variation. Several reviews commend an open, caring manager and effective case coordination, yet others describe poor communication with families, lack of multilingual staff (notably Spanish-language support), mandatory vendor restrictions (for example, provider-specific TV/phone requirements), and perceived favoritism or profit-focused decision-making in a family-operated governance model. There are also allegations of theft and property-security weaknesses that, if substantiated, would require prompt administrative and possibly legal response.
Activities and engagement appear uneven: some residents report meaningful activities and even enthusiastic water-based programs, while others note limited access to outings and few structured activities in portions of the campus. Overall, the pattern is one of variability — strong experiences for some residents and families, and operational gaps that have produced significant concerns for others. Prospective residents and families should weigh the facility’s appealing physical amenities, engaged staff members, and supportive services against documented inconsistencies in staffing, training, maintenance, food service, property management, and multilingual communication. Management attention to staffing stability, training, environmental safety, and consistent communication would address the most frequently cited weaknesses.
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Location
Fircrest Senior Living is located at 213 NE Fircrest Dr, McMinnville, OR, 97128.
About Fircrest Senior Living
FirCrest Senior Living presents a thoughtfully designed and welcoming environment, offering a range of apartment styles to suit the diverse preferences and needs of its residents. Choices include one-bedroom apartments, private studios, deluxe studios, and shared accommodations. Residents are encouraged to furnish their spaces to reflect their personal tastes, creating a sense of home and familiarity within the community. Each apartment is equipped with individually controlled heating and air conditioning systems to ensure comfort in every season. The private bathrooms feature walk-in showers, providing both convenience and safety for residents. Emergency call systems are placed in each apartment, offering additional peace of mind and ensuring that help is always close at hand.
The community is dedicated to delivering personalized care tailored to each individual, with an emphasis on maximizing independence and honoring lifelong routines. Staff at FirCrest Senior Living are trained and experienced, focusing on empowering residents to maintain the level of independence to which they are accustomed. Special attention is given to those with memory care needs, with staff exhibiting compassion, understanding, and expertise in providing this specialized support. The mission at FirCrest Senior Living is built around respect and dignity, ensuring that every resident feels valued and supported in their daily lives.
Life at FirCrest Senior Living is enriched by a sense of community and the devotion of a passionate care team. Residents are invited to participate in communal activities and social opportunities designed to promote well-being and connection. The atmosphere created by the staff is one of sincere warmth, with a commitment to going above and beyond to make residents feel comfortable, safe, and at home. FirCrest Senior Living stands out as a place where kindness, tenderness, and thoughtfulness form the foundation of daily interactions, allowing residents to thrive in a supportive and vibrant environment.
People often ask...
Fircrest Senior Living offers competitive pricing, with rates starting at a cost of $5,934 per month.
Fircrest Senior Living offers independent living, assisted living, and memory care.
There are 36 photos of Fircrest Senior Living on Mirador.
Yes, Fircrest Senior Living allows residents to age in place and adjust their level of care as needed.
The full address for this community is 213 NE Fircrest Dr, McMinnville, OR 97128.
No, Fircrest 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.
Investigated an altercation between two residents; failure to supervise and follow the care plan placed residents at risk of harm and was identified as abuse/neglect.
Abuse—Failed to follow care plan
01 Nov 2025Inspection
01 Nov 2025Inspection
Found that service plans did not reflect residents' needs or include their preferences as identified in evaluations, violating requirements.
Licensing—Failed to properly plan care
01 Nov 2025Abuse: Neglect
01 Nov 2025Abuse: Neglect
Investigated a safety neglect violation after a resident eloped through an unlatched door, briefly outside and wandering in the parking lot before re-entering; a fine was assessed.
Abuse—Failed to provide safe environment
20 Oct 2025Abuse: Neglect
20 Oct 2025Abuse: Neglect
Found a failure to provide a safe environment that risked harm to residents, with a fine assessed for the violation.
Abuse—Failed to provide safe environment
20 Oct 2025Abuse: Neglect
20 Oct 2025Abuse: Neglect
Investigated a complaint and found a failure to provide a safe environment, resulting in neglect and abuse. A $375 fine was assessed.
Abuse—Failed to provide safe environment
22 Sept 2025License Condition
22 Sept 2025License Condition
Found staffing levels did not align with ABST indicators, resulting in insufficient staff to meet resident needs.
Regulatory Action—Failed to use an ABST
22 Sept 2025License Condition
22 Sept 2025License Condition
Found insufficient staffing to meet resident needs due to inaccuracies in the acuity-based staffing tool and inconsistencies among roster, care plans, and ABST.
Regulatory Action—Failed to use an ABST
16 Sept 2025Inspection
16 Sept 2025Inspection
Investigated an allegation that care was not followed. Found that the transfer caused rib injuries, violated resident rights, and constituted neglect and abuse.
Licensing—Failed to follow care plan
05 Sept 2025Inspection
05 Sept 2025Inspection
Found a safety deficiency: operable windows on higher levels had a 25-inch sill height, which violated fall-prevention requirements.
Licensing—Failed to provide safe environment
30 Aug 2025Inspection
30 Aug 2025Inspection
Found that an acuity-based staffing tool was not developed, maintained, or implemented as required.
Licensing—Failed to use an ABST
30 Aug 2025Inspection
30 Aug 2025Inspection
Investigated a complaint and found a deficiency related to failing to maintain a safe environment, including a missing window lock blocker and elopement risk.
Licensing—Failed to provide safe environment
07 Aug 2025Inspection
07 Aug 2025Inspection
Identified that an acuity-based staffing tool was not developed, maintained, and implemented as required by the rule.
Licensing—Failed to use an ABST
25 Jul 2025Abuse: Neglect
25 Jul 2025Abuse: Neglect
Found a failure to provide a safe environment, placing a resident at risk after leaving without assistance. A $250 fine was assessed for this violation.
Abuse—Failed to provide safe environment
25 Jul 2025Abuse: Neglect
25 Jul 2025Abuse: Neglect
Found that a resident's medications were signed out multiple times and not administered, with missing drugs and financial abuse; a fine was assessed.
Abuse—Failed to protect resident from financial exploitation
22 Jul 2025Kitchen
22 Jul 2025Kitchen
Found multiple kitchen sanitation deficiencies and improper food storage. These conditions did not meet the food sanitation rules.
Investigated found a staff member verbally abused a resident and threatened harm, and the organization failed to protect the resident from verbal/emotional abuse.
Licensing—Failed to protect resident from verbal abuse
08 Jun 2025Abuse: Neglect
08 Jun 2025Abuse: Neglect
Investigated and found that staff did not answer a resident's call light in a timely manner, resulting in discomfort and constituting neglect and abuse.
Abuse—Failed to answer call light in a timely manner
25 May 2025Abuse: Neglect
25 May 2025Abuse: Neglect
Investigated a complaint and found abuse and neglect due to long waits for bladder-management assistance, causing discomfort and risk of skin breakdown.
Abuse—
12 May 2025Abuse: Neglect
12 May 2025Abuse: Neglect
Found staff failed to provide required assistance when a resident called for help, resulting in neglect and abuse. A $500 fine was assessed.
Abuse—Failed to provide service
10 Mar 2025Abuse: Neglect
10 Mar 2025Abuse: Neglect
Investigated a complaint and found staff failed to follow a one-to-one supervision care plan, allowing a resident to wander into another resident's room and cause a skin tear, resulting in abuse and neglect.
Abuse—Failed to follow care plan
14 Feb 2025Inspection
14 Feb 2025Inspection
Found insufficient staffing to meet residents' 24-hour needs due to too few qualified awake direct care staff.
Licensing—Failed to provide appropriate staffing
15 Dec 2024Abuse: Neglect
15 Dec 2024Abuse: Neglect
Investigated allegations of abuse and neglect and found safety interventions were not in place, resulting in an injury.
Abuse—Failed to properly plan care
04 Dec 2024Abuse: Neglect
04 Dec 2024Abuse: Neglect
Found a failure to provide a safe environment that led to a minor injury after a resident wandered into another resident's room and an altercation occurred.
Abuse—Failed to provide safe environment
04 Dec 2024Abuse: Neglect
04 Dec 2024Abuse: Neglect
Investigated findings showed a failure to provide a safe environment, resulting in neglect and abuse, and a $375 fine was assessed.
Abuse—Failed to provide safe environment
15 Nov 2024Abuse: Neglect
15 Nov 2024Abuse: Neglect
Determined that failure to follow the care plan caused neglect and abuse, and a $500 fine was assessed.
Abuse—Failed to follow care plan
15 Nov 2024Abuse: Neglect
15 Nov 2024Abuse: Neglect
Found neglect leading to a stage 4 pressure sore from insufficient daily care and hygiene. A $500 fine was assessed.
Abuse—Failed to provide service
03 Nov 2024Inspection
03 Nov 2024Inspection
Found a failure to ensure a safe medication administration system, with medication dispensed without observation and later taken by the resident.
Licensing—Failed to provide a safe medication administration system
18 Sept 2024Inspection
18 Sept 2024Inspection
Found direct care staffing was insufficient to meet residents' scheduled and unscheduled needs, and residents were not showered or toileted according to their service plans.
Licensing—Failed to provide appropriate staffing
19 Aug 2024Abuse: Neglect
19 Aug 2024Abuse: Neglect
Investigated and found neglect and abuse: the Alleged Victim was found with feces on their person, staff did not assist with cleanup, creating unsanitary conditions and risk of harm; a fine was assessed.
Abuse—
19 Aug 2024Abuse: Neglect
19 Aug 2024Abuse: Neglect
Identified neglect and abuse due to failing to reposition a bedbound resident and leaving bed rails down, risking discomfort and harm. A $750 fine was assessed.
Abuse—
19 Aug 2024Abuse: Neglect
19 Aug 2024Abuse: Neglect
Found that a resident did not receive required eating assistance during lunch, which violated resident rights and constituted neglect and abuse; a $750 fine was assessed.
Abuse—
19 Aug 2024Abuse: Neglect
19 Aug 2024Abuse: Neglect
Identified that the resident's care needs were not met because staff were unfamiliar with the resident's care needs and there were not enough staff, resulting in neglect and abuse.
Abuse—
08 Jul 2024Licensure
08 Jul 2024Licensure
Identified multiple deficiencies across resident rights, abuse reporting, service planning, infection control, medication administration, fire safety, and nutrition; final revisit concluded substantial compliance.
Deficiency—Comment
Deficiency—Resident Rights and Protection - General
Deficiency—Resident Move-In and Eval: Res Evaluation
Deficiency—Service Plan: General
Deficiency—Infection Prevention & Control
Deficiency—Systems: Tracking Control Substances
Deficiency—Systems: Medication Administration
Deficiency—Fire and Life Safety: Safety
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Administration Compliance
Deficiency—Compliance With Rules Health Care
Deficiency—Nutrition and Hydration
01 Jul 2024Abuse: Neglect
01 Jul 2024Abuse: Neglect
Found neglect and abuse due to delayed medication administration and failure to monitor side effects, resulting in unreasonable discomfort and a $750 fine.
Abuse—
25 Jun 2024Inspection
25 Jun 2024Inspection
Investigated a complaint and found that staff repeatedly badgered a resident to get out of bed, calling them lazy, which violated resident rights and constituted mental abuse.
Licensing—Failed to protect resident from mental or emotional abuse
25 Jun 2024Inspection
25 Jun 2024Inspection
Identified a staffing deficiency that resulted in a resident receiving only one shower weekly instead of the scheduled two.
Licensing—Failed to provide appropriate staffing
19 Jun 2024Abuse: Neglect
19 Jun 2024Abuse: Neglect
Found neglect and abuse due to failure to address fall risk in the care plan after an unwitnessed fall.
Abuse—
07 Jun 2024License Condition
07 Jun 2024License Condition
Found deficiencies in providing a safe environment and noncompliance with applicable rules.
Regulatory Action—Failed to provide safe environment
05 Jun 2024Complaint
05 Jun 2024Complaint
Investigated and identified multiple deficiencies in policy implementation for sexual assault referrals, resident monitoring and safety, RN notification of nursing needs, and administrative oversight.
Identified abuse and neglect due to staff failing to provide one-to-one supervision and to follow the resident's service plan, placing the resident at risk.
Abuse—Failed to follow care plan
03 Jun 2024Inspection
03 Jun 2024Inspection
Investigated a complaint about meals and found that a resident did not receive three meals a day, violating rules.
Licensing—Failed to provide proper food/nutrition
03 Jun 2024Inspection
03 Jun 2024Inspection
Found a deficiency for failing to provide written communication of a resident's change of condition and required interventions to direct care staff on each shift.
Licensing—Failed to provide oversight and monitoring of change of condition
02 Jun 2024Abuse: Neglect
02 Jun 2024Abuse: Neglect
Investigated found neglect and abuse due to inadequate one-to-one supervision and failure to protect a resident from sexual harm.
Abuse—Failed to perform adequate screening or assessment
01 Jun 2024Inspection
01 Jun 2024Inspection
Determined that the licensee failed to monitor residents according to their evaluated needs and service plans and did not provide one-on-one supervision for safety.
Licensing—Failed to provide safe environment
01 Jun 2024Complaint
01 Jun 2024Complaint
Identified deficiencies across several areas. Issues included administration notification, resident rights protection, meals sanitation, condition monitoring, staffing, and call systems.
Deficiency—Licensing Complaint Investigation
Deficiency—Facility Administration: Notification
Deficiency—Resident Rights and Protection - General
Deficiency—Resident Rights and Protection: Personal Rela
Deficiency—Staffing Requirements and Training: Staffing
Deficiency—Acuity-Based Staffing Tool
Deficiency—Call Sys, Exit Dr Alarm, Phones, Tv, Or Cable
Deficiency—Call System
01 Jun 2024Inspection
01 Jun 2024Inspection
Investigated and found a policy failure to refer potential sexual assault victims to the nearest trained examiner within 86 hours, violating applicable Oregon rules.
Licensing—Failed to provide safe environment
01 Jun 2024Inspection
01 Jun 2024Inspection
Found insufficient administrative oversight over memory care operations, with potential safety implications.
Licensing—Failed to provide safe environment
01 Jun 2024Abuse: Neglect
01 Jun 2024Abuse: Neglect
Investigated found that staff failed to implement safety measures after a sexual incident, placing a resident at risk of serious harm and constituting abuse and neglect.
Abuse—Failed to properly plan care
01 Jun 2024Inspection
01 Jun 2024Inspection
Identified a deficiency that the RN was not notified of a resident incident, violating Oregon Administrative Rules.
Licensing—Failed to perform adequate screening or assessment
30 May 2024License Condition
30 May 2024License Condition
Investigated an allegation of failing to provide a safe environment and identified deficiencies related to safety standards.
Regulatory Action—Failed to provide safe environment
27 May 2024Abuse: Neglect
27 May 2024Abuse: Neglect
Found a failure to provide a safe environment due to inadequate supervision, placing a resident at risk when another resident pushed them after wandering into a room; a $250 fine was assessed.
Abuse—Failed to provide safe environment
25 May 2024Inspection
25 May 2024Inspection
Found a deficiency in the call system that failed to connect resident units to the care staff center or pagers and was not operable, violating Oregon Administrative Rules.
Licensing—Failed to provide safe environment
25 May 2024Abuse: Neglect
25 May 2024Abuse: Neglect
Investigated a failure to respond to a resident's call light in a timely manner, which caused discomfort and concern for neglect and abuse.
Abuse—Failed to answer call light in a timely manner
22 May 2024Inspection
22 May 2024Inspection
Found that a staff member yelled at a resident with profanity and did not follow the resident's behavioral service plan, constituting verbal abuse and neglect.
Licensing—Failed to protect resident from verbal abuse
02 May 2024Inspection
02 May 2024Inspection
Investigated and found that staff acted as a resident's guardian, violating Oregon Administrative Rules.
Licensing—Failed to provide safe environment
30 Apr 2024Inspection
30 Apr 2024Inspection
Determined that a call system connecting resident units to care staff was not provided for two to three weeks, creating a safety deficiency.
Licensing—Failed to provide safe environment
24 Apr 2024Abuse: Neglect
24 Apr 2024Abuse: Neglect
Investigated and found neglect and abuse due to failure to provide proper catheter care, causing leakage, discomfort, and loss of personal dignity; a $500 fine was assessed.
Abuse—Failed to provide service
23 Apr 2024Inspection
23 Apr 2024Inspection
Investigated and found a failure to notify the Department within 72 hours after severe interruption of essential services, including call light system downtime.
Licensing—Failed to provide safe environment
23 Apr 2024Inspection
23 Apr 2024Inspection
Found a failure to provide a call system connecting resident units to care staff, leaving residents without a call light for two months.
Licensing—Failed to provide safe environment
23 Apr 2024Inspection
23 Apr 2024Inspection
Investigated a complaint about insufficient qualified awake direct care staff to meet residents' 24-hour needs, including checks every 30 minutes in the absence of a call light system.
Licensing—Failed to follow care plan
03 Apr 2024Licensure
03 Apr 2024Licensure
Identified ongoing kitchen sanitation and storage deficiencies across multiple visits; subsequent follow-up determined substantial compliance.
Deficiency—Inspections and Investigation: Insp Interval
03 Apr 2024Licensure
03 Apr 2024Licensure
Found ongoing sanitation and storage deficiencies in the kitchen with repeated violations across multiple visits and failure to implement corrective actions.
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Administration Compliance
03 Apr 2024Inspection
03 Apr 2024Inspection
Determined that ABST was not updated to reflect residents and their care needs, with inconsistencies between the roster, care plans, and ABST data.
Licensing—Failed to use an ABST
02 Apr 2024Abuse: Neglect
02 Apr 2024Abuse: Neglect
Investigated allegations of neglect due to a non-operational call light system that prevented a resident from requesting staff assistance. Found that the call system failure placed the resident at risk for serious harm and violated resident rights.
Abuse—Failed to provide service
18 Sept 2023License Condition
18 Sept 2023License Condition
Investigated and found a failure to use an acuity-based staffing tool showing all residents with the 22 required care elements with staff time to complete them.
Regulatory Action—Failed to use an ABST
12 Sept 2023Abuse: Neglect
12 Sept 2023Abuse: Neglect
Found neglect and abuse due to failure to provide prescribed physical therapy after a fall, leaving the resident unable to ambulate; a $2,500 fine was assessed.
Abuse—Failed to provide service
07 Sept 2023License Condition
07 Sept 2023License Condition
Found failure to use an acuity-based staffing tool that showed all residents with the 22 required care elements and staff time to complete them.
Regulatory Action—Failed to use an ABST
15 Aug 2023Validation
15 Aug 2023Validation
Investigated multiple deficiencies across operations, safety systems, care planning, and staffing, including failures in safeguards, timely notifications, treatment orders, and resident rights protections; overall found substantial compliance at the final review.
Concluded substantial compliance with licensing rules. However, numerous deficiencies were identified across resident safety, nutrition, infection control, medication management, service planning, and staff training during the review.
Deficiency—Comment
Deficiency—Reasonable Precautions
Deficiency—Resident Rights and Protection - General
Deficiency—Service Plan: General
Deficiency—Service Plan: Service Planning Team
Deficiency—Infection Prevention & Control
Deficiency—Systems: Tracking Control Substances
Deficiency—Systems: Treatment Orders
Deficiency—Systems: Medication Administration
Deficiency—Systems: Psychotropic Medication
Deficiency—Restraints and Supportive Devices
Deficiency—Acuity-Based Staffing Tool
Deficiency—Fire and Life Safety: Safety
Deficiency—Fire and Life Safety: Training For Residents
Deficiency—Inspections and Investigation: Insp Interval
Deficiency—Doors, Walls, Elevators, Odors
Deficiency—Individual Privacy: Own Unit
Deficiency—Administration Compliance
Deficiency—Staff Training Requirements
Deficiency—Compliance With Rules Health Care
Deficiency—Nutrition and Hydration
Deficiency—Activities
Deficiency—Secure Outdoor Recreation Area
Deficiency—Resident Rooms
16 May 2023Inspection
16 May 2023Inspection
Found that direct care staff competency was not determined, indicating a staffing deficiency.
Licensing—Failed to provide appropriate staffing
09 Apr 2023Abuse: Neglect
09 Apr 2023Abuse: Neglect
Found neglect and abuse due to failure to monitor a resident's changing condition and follow the care plan, which contributed to a toe amputation.
Abuse—Failed to provide oversight and monitoring of change of condition
19 Mar 2023Abuse: Neglect
19 Mar 2023Abuse: Neglect
Found failures to plan and implement fall-risk care, resulting in resident discomfort and neglect.
Abuse—Failed to properly plan care
21 Feb 2023Licensure
21 Feb 2023Licensure
Identified deficiencies in kitchen sanitation practices and administration compliance, with a follow-up showing substantial compliance after corrective actions.
Investigated and found care planning failures led to hospitalization and abuse findings; a fine was assessed.
Abuse—Failed to properly plan care
11 Dec 2021Abuse: Neglect
11 Dec 2021Abuse: Neglect
Investigated and found that the licensee failed to provide a safe environment, resulting in injuries to a resident. A $188 fine was assessed.
Abuse—Failed to provide safe environment
06 Dec 2021Abuse: Neglect
06 Dec 2021Abuse: Neglect
Concluded that a safe environment was not provided, resulting in resident-to-resident abuse and neglect; a fine was assessed.
Abuse—Failed to provide safe environment
10 Apr 2021Inspection
10 Apr 2021Inspection
Investigated and found a staff member failed to administer medication as ordered, and the medication system was unsafe.
Licensing—Failed to provide a safe medication administration system
28 Dec 2020Abuse: Neglect
28 Dec 2020Abuse: Neglect
Found a failure to provide a safe medication administration system, leading to neglect and abuse as the resident did not receive prescribed pain medication between December 24 and December 28, 2020.
Abuse—Failed to provide a safe medication administration system
23 Jul 2020Inspection
23 Jul 2020Inspection
Investigated the allegation of improper food/nutrition and found violations of Food Sanitation Rules.
Licensing—Failed to provide proper food/nutrition
23 Jul 2020Inspection
23 Jul 2020Inspection
Investigated and found a failure to provide reasonable precautions against conditions that may threaten residents' health, safety, or welfare.
Licensing—Failed to assure resident was safe
07 May 2020Inspection
07 May 2020Inspection
Determined that a staff member financially exploited a resident by taking money and accepting gifts, and that a safe environment was not provided for the resident.
Licensing—Failed to provide safe environment
10 Feb 2020Inspection
10 Feb 2020Inspection
Investigated the allegation of failing to serve food as required by Food Sanitation Rules and verified a licensing violation.
Licensing—Failed to assure food safety
08 May 2019Abuse: Physical Abuse
08 May 2019Abuse: Physical Abuse
Determined that abuse occurred and basic care, services, and supervision were not provided to protect a resident from being yelled at, spit at, and grabbed.
Abuse—Failed to protect resident from rough treatment
08 May 2019Inspection
08 May 2019Inspection
Found a violation for failing to provide a safe environment by neglecting basic care, services, and supervision.
Licensing—Failed to provide safe environment
05 Mar 2019Abuse: Sexual abuse
05 Mar 2019Abuse: Sexual abuse
Concluded that a caregiver neglected a resident, resulting in distress and a risk of sexual assault, with a fine assessed.
Abuse—Failed to protect resident from inappropriate sexual contact
17 Oct 2018Inspection
17 Oct 2018Inspection
Investigated a housekeeping allegation and found that carpets and floors were dirty due to inadequate cleaning.
Licensing—Failed to provide appropriate housekeeping services
01 Feb 2018Abuse: Neglect
01 Feb 2018Abuse: Neglect
Found that there was a failure to utilize a reliable medication administration system, causing a medication error with physical harm, and a fine was assessed.
Abuse—Failed to administer medication as ordered
08 Jan 2018Inspection
08 Jan 2018Inspection
Investigated the allegation of failing to assure food safety and found a deficiency.
Licensing—Failed to assure food safety
19 May 2017Abuse: Financial abuse
19 May 2017Abuse: Financial abuse
Found that a resident was not protected from financial exploitation when a staff member stole medications.
Abuse—Failed to protect resident from financial exploitation
04 Apr 2017Inspection
04 Apr 2017Inspection
Found that staff failed to intervene when a resident's condition changed, leading to a resident striking another and causing emotional distress.
Licensing—Failed to intervene when resident's condition changed
31 Mar 2017Inspection
31 Mar 2017Inspection
Investigated an allegation of failing to intervene when a resident's condition changed; found that staff did not assess the situation and intervene, which led to a resident being attacked.
Licensing—Failed to intervene when resident's condition changed
14 Mar 2017Inspection
14 Mar 2017Inspection
Found that care was not provided appropriately, resulting in an altercation.
Licensing—Failed to properly plan care
11 Feb 2017Abuse: Neglect
11 Feb 2017Abuse: Neglect
Investigated an abuse/neglect allegation and identified a failure to assess and intervene, resulting in a resident being punched.
Abuse—Failed to provide safe environment
28 Jan 2017Abuse: Neglect
28 Jan 2017Abuse: Neglect
Found that residents were not protected from a resident-to-resident altercation, resulting in minor injuries.
Abuse—Failed to provide safe environment
19 Aug 2016Inspection
19 Aug 2016Inspection
Identified insufficient staffing contributing to long wait times for resident assistance and delays with transfers.
Licensing—Failed to provide appropriate staffing
19 Aug 2016Inspection
19 Aug 2016Inspection
Investigated deficiencies in following care and service plans, resulting in irregular support with showers, transfers, toileting, and other required tasks for multiple residents.
Licensing—Failed to follow care plan
04 Aug 2016Inspection
04 Aug 2016Inspection
Investigated and found a failure to protect resident rights due to inappropriate verbal behavior by staff.
Licensing—Failed to assure resident rights
29 Jul 2016Inspection
29 Jul 2016Inspection
Found a deficiency in medication administration due to failure to provide medications as ordered.
Licensing—Failed to provide a safe medication administration system
18 Feb 2016Inspection
18 Feb 2016Inspection
Investigated and found that residents did not receive adequate structured activities; group activities were limited and one-on-one interactions predominated.
Licensing—Failed to provide appropriate activities
26 Oct 2015Abuse: Neglect
26 Oct 2015Abuse: Neglect
Investigated a neglect allegation and found that staff failed to follow the care plan, leaving residents' care needs unmet.
Abuse—Failed to follow care plan
09 Sept 2015Inspection
09 Sept 2015Inspection
Found that appropriate activities were not provided as required.
Licensing—Failed to provide appropriate activities
09 Sept 2015Inspection
09 Sept 2015Inspection
Found that laundry services were not provided as described, indicating a deficiency in maintaining a safe living environment.
Licensing—Failed to maintain a safe physical environment
06 Apr 2015Abuse: Neglect
06 Apr 2015Abuse: Neglect
Found failure to follow the care plan; a $300 fine was assessed.
Abuse—Failed to follow care plan
08 Oct 2014Abuse: Neglect
08 Oct 2014Abuse: Neglect
Found that staff failed to provide adequate care to meet the resident's needs.
Abuse—Failed to assist with toileting
31 Aug 2014Abuse: Neglect
31 Aug 2014Abuse: Neglect
Investigated the allegation of unsafe medication administration and found a failure to maintain an adequate medication management system.
Abuse—Failed to provide a safe medication administration system
15 Aug 2014Inspection
15 Aug 2014Inspection
Identified a deficiency in medication administration safety. Found failure to provide an appropriate medication administration system.
Licensing—Failed to provide a safe medication administration system
06 Aug 2013Abuse: Neglect
06 Aug 2013Abuse: Neglect
Found neglect due to failing to address a resident's behavior and to keep RV2 safe.
Abuse—Failed to address resident's behavior
18 Jul 2013Inspection
18 Jul 2013Inspection
Investigated an allegation of failing to protect resident rights and found that an argument about a scheduling conflict caused emotional distress to a resident.
Licensing—Failed to assure resident rights
26 Jun 2013Abuse: Financial abuse
26 Jun 2013Abuse: Financial abuse
Found a deficiency in safeguarding medications due to failure to provide a safe environment.
Abuse—Failed to provide safe environment
31 May 2013Inspection
31 May 2013Inspection
Determined that resident rights were not protected and privacy was compromised.
Licensing—Failed to assure resident rights
02 Feb 2012Abuse: Neglect
02 Feb 2012Abuse: Neglect
Found neglect resulted in an unsafe environment.
Abuse—Failed to provide safe environment
29 Sept 2010Inspection
29 Sept 2010Inspection
Found failure to provide appropriate care to a resident.
Licensing—Failed to provide service
08 Apr 2010Inspection
08 Apr 2010Inspection
Concluded substantiation of the allegation that staff failed to intervene when a resident's condition changed.
Licensing—Failed to intervene when resident's condition changed
12 Mar 2010Abuse: Neglect
12 Mar 2010Abuse: Neglect
Found a failure to provide a safe environment.
Abuse—Failed to provide safe environment
19 Feb 2010Abuse: Neglect
19 Feb 2010Abuse: Neglect
Investigated and found a failure to provide a safe environment.
Abuse—Failed to provide safe environment
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