Pricing ranges from
    $4,823 – 6,269/month

    Brookdale Salem

    1355 Boone Rd SE, Salem, OR 97306
    • Independent Living
    • Assisted Living
    • Memory Care

    Genuinely caring memory care, recommended

    I placed my aunt in Brookdale Salem for memory care and I'm very pleased. The staff are genuinely caring, attentive and treated her like family; communication was clear and move-in support smooth. The building is clean and home-like, meals and activities keep residents engaged, and dignity and professional expertise for dementia care are evident. I'm grateful for the compassionate team and would recommend this community.

    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

    4.25·(77)

    Overall rating

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

      4.3
    • Staff

      4.3
    • Meals

      3.2
    • Amenities

      3.5
    • Value

      2.7

    Pros

    • Compassionate, attentive caregiving staff
    • Dementia-specialized memory care expertise
    • Engaging, varied activity programming
    • Regular social events and fundraisers
    • On-site RN and nurse practitioner availability
    • On-site beauty salon
    • Chef involvement and customized dining options
    • Clean, well-maintained common areas
    • Home-like, village-style main areas (Town Square)
    • Secure entry and keypad exits
    • Private L-shaped room options
    • Indoor courtyard and outdoor access
    • Personalized assistance with dressing and hygiene
    • Coordinated communication with families
    • Compassionate end-of-life care coordination
    • Pet-friendly policy
    • Modern, attractive facility design
    • Daily personal care support available
    • Supportive transition and move-in assistance
    • Responsive executive leadership at times
    • Residents demonstrate improved mood and engagement
    • Medicaid spin-down / payment flexibility in some cases
    • Active safety redirection and monitoring
    • Generally positive meal quality and variety
    • Neighborhood-like community feel

    Cons

    • Inconsistent staffing levels, especially at meals, nights, and weekends
    • Unreliable meal-service continuity and delayed feeding
    • Sanitation and cleaning inconsistencies in some areas
    • Incontinence-care delays and inconsistent bathing schedules
    • Variable caregiver training and competency
    • Inconsistent responsiveness to call lights and care requests
    • Lack of pricing transparency and complex add-on fees
    • Mixed resident acuity within units leading to poor fit for some
    • Environmental maintenance hazards and unsecured fixtures
    • Limited individual room climate controls and cold common dining areas
    • Laundry-management gaps and misplaced clothing
    • Variable medication-handling practices and high pharmacy costs
    • Activity programming not always tailored across ability levels
    • Occasional management and family-communication gaps

    Summary of reviews

    Reviews of Brookdale Salem present a broadly mixed but specific picture: many families and visitors praise the facility's dementia expertise, compassionate frontline staff, and attractive, village‑style common spaces. The community is frequently described as clean, home-like, and secure, with features such as a Town Square concept, indoor courtyard, on-site salon, and private room options. Clinical resources including an on-site RN and nurse practitioner, active chef involvement, and coordinated end-of-life support with hospice are cited as strengths that contribute to individualized care for many residents.

    At the same time, a recurring operational theme across accounts is inconsistency. Staffing levels are described as uneven — particularly during meal times, nights, and weekends — which reviewers link to delayed meal service, missed feedings, and slower responses to call lights. Relatedly, several reviewers raised concerns about personal-care workflows (for example, bathing and toileting assistance) and general sanitation consistency in certain areas. These patterns suggest gaps in staffing allocation, training, and workload management rather than a uniform lack of effort from individual caregivers.

    Staff quality is a notable mixed area. Many reviews single out individual caregivers, nurses, and leadership for being compassionate, responsive, and above-and-beyond; others describe variability in caregiver skill, communication tone, and adherence to procedures. Management impressions are similarly mixed: some families report helpful, hands-on executive leadership and smooth transitions, while others mention aggressive sales practices, opaque billing and add-on fees, and occasional lapses in family communication.

    Dining and activities are largely strengths with caveats. The food quality and chef engagement receive many positive mentions, and activity programming (movies, exercise, fundraisers, and memory-care–focused events) is a consistent positive for resident engagement. However, the delivery of dining service is sometimes hampered by staffing constraints, and activity offerings may not always be consistently tailored to both higher- and lower-functioning residents or fully available during pandemic-related restrictions.

    Facilities and safety are generally viewed positively in terms of design, cleanliness, and security features, but reviewers also note maintenance and environmental hazards (loose fixtures or unsecured items) and practical limits such as lack of individual temperature controls, occasional cold dining rooms, and constrained front-entrance parking. Financial and administrative transparency is another area families should evaluate carefully: reviewers cite unclear base pricing versus add-on charges, occasional invoice discrepancies, and pharmacy cost concerns.

    Recommendation for prospective families: Brookdale Salem demonstrates genuine strengths in memory-care programming, compassionate individual staff members, and appealing campus amenities. At the same time, consistent questions arise around staffing adequacy, meal-service continuity, sanitation processes, caregiver training, and billing transparency. Prospective residents and families should visit multiple times (including meal times and evenings), ask for current staffing ratios, review infection-control and personal-care protocols, request a sample invoice with all potential add-ons, and inquire about medication- and laundry-management processes before deciding. Observing staff-resident interactions and confirming how the community handles higher-acuity residents will help determine whether this community is a good operational fit for a given care need.

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    Location

    Map showing location of Brookdale Salem

    Brookdale Salem is located at 1355 Boone Rd SE, Salem, OR, 97306.

    About Brookdale Salem

    Brookdale Salem is a licensed senior living community with the state license number 1063512146, and offers care for 60 residents, all in memory care. This place has assisted living, independent living, memory care, skilled nursing, and at-home care services, so folks can get the help they need without moving around, and it works especially well for people living with Alzheimer's, dementia, and other memory conditions because it's set up just for them with staff trained in memory care, building features designed for safety, and special programs like Clare Bridge, which gives six planned activities every day, and the Solace program, which helps residents in the later stages of dementia. The staff stays available 24 hours a day for emergencies, and there's a nurse on duty part-time, so residents don't wait long for help with health needs. People can stay in cozy studios, one-bedroom apartments, or friendship suites ranging from 315 to 625 square feet, and the rooms let folks bring their pets with them, making the place feel more like home, especially since the inside looks and feels like a private house with smaller scaled-down spaces and comfortable touches, which helps residents relax. There are indoor and enclosed outdoor walking paths, so folks with memory issues can walk around safely, and the outdoor grounds are good for walks and other activities in the fresh air. Residents get healthy and tasty meals in a dining area, and common spaces like a therapy room, chapel, ice cream parlor, game room, library, and arts and crafts studio, along with Wi-Fi for keeping in touch or entertainment, make it easy to spend time with others. People pay using credit cards or checks, and there's a supportive management team that listens and responds quickly to staff and resident needs, which helps give the place a friendly, welcoming feel. Events and activities fill the days, focusing on fun, wellness, socializing, and keeping minds and bodies active, with programs made to reduce confusion and make daily life smoother for people with memory loss. Brookdale Salem always follows state rules, has earned praise for care and communication, and has won awards like Best of Senior Living for its support, respect, and kindness toward residents and their families.

    About Brookdale

    Brookdale Salem is managed by Brookdale.

    Brookdale Senior Living Inc. (NYSE: BKD) is the largest senior living operator in the United States, managing over 640 communities with capacity for approximately 59,000 residents across 41 states and employing around 36,000 associates. Founded in 1978 and publicly traded since 2005, Brookdale solidified its market leadership through major acquisitions including American Retirement Corporation (2006) and Emeritus Senior Living (2014), making it the only national full-spectrum senior living company. Headquartered in Nashville, Tennessee, Brookdale has topped the American Seniors Housing Association's ASHA 50 list and Argentum's largest providers list for multiple consecutive years.

    The company's comprehensive care continuum includes independent living, assisted living, memory care, skilled nursing, and continuing care retirement communities (CCRCs). Brookdale's signature Clare Bridge program, developed over 30 years ago by dementia-care experts, provides specialized Alzheimer's and dementia care through two distinct levels: Clare Bridge communities for comprehensive memory support and the Clare Bridge Solace program for advanced-stage dementia residents. The program is recognized by the Alzheimer's Association® for incorporating evidence-based Dementia Care Practice Recommendations and features secure environments, enclosed courtyards, Daily Path programming with six structured activities daily, and the InTouch technology platform offering personalized brain-stimulating games and therapeutic content.

    Brookdale's holistic Optimum Life® wellness approach balances six dimensions—Purposeful, Physical, Emotional, Social, Spiritual, and Intellectual—implemented through signature programs including B-Fit (eight exercise class options), Brain Fit (mental fitness workouts), My Life Story (resident storytelling), EngagementPlus (interest-based connections), Growing Together (collaborative learning), and The Ageless Spirit (kindness and gratitude practices). The Embrace Family Partnership provides caregiver education and support for families of memory care residents.

    The company's Brookdale HealthPlus® care coordination model, winner of the 2024 Argentum Best of the Best Award placing it among the top 1% of operators, is a technology-enabled healthcare service featuring dedicated RN Care Managers who proactively manage residents' health, coordinate care transitions, and help prevent avoidable hospitalizations. Communities using HealthPlus report 78% fewer urgent care visits, 36% fewer hospitalizations, and 63% more completed annual wellness visits. The Personal Solutions program delivers hygiene products, medications, and daily necessities directly to residents' doors with discreet packaging and monthly billing convenience.

    Following a strategic divestiture of its home health and hospice operations to HCA Healthcare (completed December 2023), Brookdale now focuses exclusively on senior living operations while maintaining its position as the industry's largest operator, committed to its mission of enriching lives with compassion, respect, excellence, and integrity.

    People often ask...

    Brookdale Salem offers competitive pricing, with rates starting at a cost of $4,823 per month.

    Brookdale Salem offers independent living, assisted living, and memory care.

    There are 18 photos of Brookdale Salem on Mirador.

    Yes, Brookdale Salem allows residents to age in place and adjust their level of care as needed.

    The full address for this community is 1355 Boone Rd SE, Salem, OR 97306.

    No, Brookdale Salem 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 number5MA205
    StatusActive
    Facility typeResidential Care Facility
    Capacity60 residents
    LicenseeBrookdale Senior Living Communities, Inc
    EffectiveMay 19th, 1999
    Special certificationMemory Care
    View the official license record

    Inspection Reports

    177

    Reports

    0

    Type A Citations

    0

    Type B Citations

    1

    Complaints

    16

    Years

    07 Jan 2026Abuse: Neglect
    Identified a failure to provide a safe environment that led to a resident-to-resident altercation and a $375 fine.
    • AbuseFailed to provide safe environment
    08 Dec 2025Inspection
    Investigated an allegation of unsafe medication administration and found a discontinued drug was given to a resident. This occurred without proper notification to relevant parties and indicated a failure to oversee the medication system.
    • LicensingFailed to provide a safe medication administration system
    25 Nov 2025Inspection
    Investigated and found a resident rights violation due to wrongful restraint, resulting in a $375 fine.
    • LicensingFailed to assure resident rights
    13 Oct 2025Abuse: Neglect
    Investigated and found neglect and abuse due to failure to plan fall-prevention interventions, leading to multiple falls and a fractured hip, with a fine assessed.
    • AbuseFailed to properly plan care
    25 Aug 2025Abuse: Neglect
    Investigated a case where staff failed to follow a care plan to separate residents with a history of altercations, resulting in injury and a fine.
    • AbuseFailed to provide safe environment
    26 Jul 2025Abuse: Neglect
    Found that the resident's repeated falls were not addressed with appropriate interventions. This resulted in neglect and abuse and a $500 fine was assessed.
    • AbuseFailed to follow care plan
    10 Jun 2025Abuse: Neglect
    Investigated found failure to properly plan care after a change of condition, resulting in a resident-to-resident altercation and neglect/abuse.
    • AbuseFailed to properly plan care
    11 Apr 2025Inspection
    Identified a safety issue in medication administration where a resident received another resident's heart medication, causing a drop in blood pressure and hospitalization.
    • LicensingFailed to provide a safe medication administration system
    31 Mar 2025Inspection
    Found a violation for not keeping interior and exterior surfaces clean, including a corner that was repeatedly urinated on.
    • LicensingFailed to provide safe environment
    26 Mar 2025Inspection
    Investigated a medication administration incident in which a staff member in training gave another resident's medication without supervision, causing a heart rate drop and hospital transfer.
    • LicensingFailed to provide a safe medication administration system
    14 Feb 2025Abuse: Neglect
    Found that the care plan was not followed, leading to a resident-to-resident altercation; a $375 fine was assessed.
    • AbuseFailed to follow care plan
    14 Jan 2025Abuse: Neglect
    Investigated and found that the care plan for a resident with a history of altercations was not followed, resulting in an altercation and injury; a $375 fine was assessed.
    • AbuseFailed to follow care plan
    23 Dec 2024Abuse: Neglect
    Investigated and found that a safe environment was not provided for a resident with a history of conflicts, resulting in an altercation and injuries.
    • AbuseFailed to provide safe environment
    06 Sept 2024Abuse: Neglect
    Investigated and found neglect of care due to failure to properly plan for a resident's fall risk, resulting in a fracture.
    • AbuseFailed to properly plan care
    01 Jul 2024Licensure
    Determined substantial compliance with meals-related requirements.
    • DeficiencyComment
    09 May 2024Abuse: Neglect
    Found that the care plan safety checks were not followed, leading to multiple falls and injuries. A fine was assessed.
    • AbuseFailed to follow care plan
    11 Apr 2024Inspection
    Found that a staff member confined a resident to bed by wrapping the legs with a sheet, constituting abuse and neglect and violating resident rights.
    • LicensingFailed to follow care plan
    24 Mar 2024Abuse: Neglect
    Investigated an allegation of neglect found that care planning for falls was inadequate, resulting in multiple falls and a hip fracture; a fine was assessed.
    • AbuseFailed to properly plan care
    20 Mar 2024Abuse: Neglect
    Investigated the allegation that care wasn’t properly planned; found three falls occurred without documented fall interventions to prevent them, indicating neglect and abuse.
    • AbuseFailed to properly plan care
    07 Mar 2024Inspection
    Found that a staff member failed to follow the care plan, resulting in a fall and injuries for a known fall risk resident; identified neglect and abuse.
    • LicensingFailed to follow care plan
    06 Mar 2024Abuse: Neglect
    Investigated an allegation of neglect found the resident did not receive an ordered anti-psychotic medication for about four days, resulting in an emergency department visit and discomfort. Violations of resident rights and neglect of care were identified.
    • AbuseFailed to administer medication as ordered
    27 Feb 2024Abuse: Neglect
    Investigated and found that care plan interventions were not followed, leading to neglect and abuse findings and a fine.
    • AbuseFailed to follow care plan
    14 Feb 2024Abuse: Neglect
    Investigated and found a failure to provide a safe environment that resulted in harm to a resident.
    • AbuseFailed to provide safe environment
    13 Feb 2024License Condition
    Found a failure to provide a safe environment that put residents at risk. Multiple safety and environmental rules were cited.
    • Regulatory ActionFailed to provide safe environment
    29 Jan 2024Abuse: Neglect
    Found that a resident's care plan wasn't followed, resulting in a choking incident and discomfort; a fine was assessed.
    • AbuseFailed to follow care plan
    13 Jan 2024Abuse: Neglect
    Investigated abuse/neglect allegations; found staff failed to follow a temporary service plan, resulting in a resident being forcibly removed and bruised, with a $500 fine assessed.
    • AbuseFailed to follow care plan
    08 Dec 2023Abuse: Neglect
    Investigated and found failure to provide a safe environment, resulting in abuse and neglect with harm to a resident.
    • AbuseFailed to provide safe environment
    06 Dec 2023Abuse: Neglect
    Found neglect and abuse due to failure to properly plan care, which led to a resident fall and wrist injury; a $500 fine was assessed.
    • AbuseFailed to properly plan care
    30 Nov 2023Abuse: Neglect
    Investigated an allegation of neglect related to fall history and found inadequate interventions and care planning, resulting in an unwitnessed fall with head/face injury and pain.
    • AbuseFailed to properly plan care
    23 Nov 2023Abuse: Neglect
    Found a violation for failing to follow the care plan to keep residents separated. The resulting resident-to-resident altercation caused injuries.
    • AbuseFailed to follow care plan
    22 Nov 2023Abuse: Neglect
    Found failure to properly plan care related to a resident's fall history, resulting in an unwitnessed fall and injury; a $450 fine was assessed.
    • AbuseFailed to properly plan care
    11 Nov 2023Abuse: Neglect
    Investigated a complaint and found a failure to provide a safe environment, resulting in harm to a resident; a $500 fine was assessed.
    • AbuseFailed to provide safe environment
    08 Nov 2023Abuse: Neglect
    Identified neglect due to failure to plan care after a resident's fall history, resulting in an unwitnessed fall and a skin tear with pain. A $500 fine was assessed.
    • AbuseFailed to properly plan care
    31 Aug 2023Abuse: Neglect
    Found failure to properly plan care related to fall history, leading to an unwitnessed fall and injury; a fine was assessed.
    • AbuseFailed to properly plan care
    28 Aug 2023Validation
    Identified widespread deficiencies across administrative oversight, resident care, safety, nutrition, activities, and environmental conditions with several risks to residents.
    • DeficiencyComment
    • DeficiencyFacility Administration: Operation
    • DeficiencyFacility Administration: Required Postings
    • DeficiencyReasonable Precautions
    • DeficiencyResident Rights and Protection - General
    • DeficiencyReporting & Investigating Abuse-Other Action
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyResident Services: Activities
    • DeficiencyResident Services: Adls
    • DeficiencyResident Move-In and Eval: Res Evaluation
    • DeficiencyService Plan: General
    • DeficiencyChange of Condition and Monitoring
    • DeficiencyResident Health Services
    • DeficiencyRes Hlth Srvc: On- and Off-Site Health Srvc
    • DeficiencyRestraints and Supportive Devices
    • DeficiencyStaffing Requirements and Training: Staffing
    • DeficiencyAcuity-Based Staffing Tool
    • DeficiencyInspections and Investigation: Insp Interval
    • DeficiencyDoors, Walls, Elevators, Odors
    • DeficiencyCall Sys, Exit Dr Alarm, Phones, Tv, Or Cable
    • DeficiencyAdministration Compliance
    • DeficiencyCompliance With Rules Health Care
    • DeficiencyNutrition and Hydration
    • DeficiencyActivities
    • DeficiencyOutside Area
    • DeficiencyResident Rooms
    24 Aug 2023Abuse: Neglect
    Found failure to implement interventions and appropriately plan care for the resident's fall history, resulting in an unwitnessed fall with facial injury and unnecessary discomfort, constituting neglect and abuse.
    • AbuseFailed to properly plan care
    19 Aug 2023Abuse: Neglect
    Found neglect and abuse for failing to provide a safe environment, and assessed a $375 fine.
    • AbuseFailed to provide safe environment
    19 Aug 2023Abuse: Neglect
    Found that staff failed to implement interventions and an appropriate care plan for a fall history, leading to an unwitnessed fall with back injury and pain. This resulted in neglect and abuse.
    • AbuseFailed to properly plan care
    17 Aug 2023Abuse: Neglect
    Investigated a fall-related neglect allegation and found failures to plan and implement care interventions for fall risk, resulting in an unwitnessed fall and injury.
    • AbuseFailed to properly plan care
    17 Aug 2023Abuse: Neglect
    Found failures to implement progressive interventions to prevent repeated falls, resulting in injury and harm to a resident. The issues were classified as abuse and neglect.
    • AbuseFailed to properly plan care
    11 Aug 2023Abuse: Neglect
    Investigated and found a failure to provide a safe environment that led to a resident-to-resident altercation and harm.
    • AbuseFailed to provide safe environment
    01 Aug 2023Abuse: Neglect
    Investigated a complaint and found a failure to provide a safe environment, resulting in an injury from a resident-to-resident altercation.
    • AbuseFailed to provide safe environment
    01 Aug 2023Abuse: Neglect
    Identified a failure to provide a safe environment that resulted in an injury, and a $500 fine was assessed.
    • AbuseFailed to provide safe environment
    25 Jul 2023Abuse: Neglect
    Found neglect and abuse due to failure to implement interventions for the resident's fall history, which led to an unwitnessed fall and head injury.
    • AbuseFailed to provide safe environment
    23 Jul 2023Abuse: Neglect
    Found neglect due to failure to implement interventions and plan care after a fall history, resulting in injury and discomfort; a $500 fine was assessed.
    • AbuseFailed to properly plan care
    22 Jun 2023Abuse: Neglect
    Found that care planning for a resident’s known fall history was inadequate, leading to injuries requiring hospital treatment.
    • AbuseFailed to properly plan care
    11 Jun 2023Abuse: Neglect
    Identified neglect and abuse due to failure to provide a safe environment.
    • AbuseFailed to provide safe environment
    03 May 2023Abuse: Neglect
    Investigated a resident fall-related care planning issue and found deficient interventions and care planning for the resident's fall history, resulting in an unwitnessed fall and injury.
    • AbuseFailed to properly plan care
    01 May 2023Abuse: Neglect
    Investigated found failure to implement interventions and care planning for a resident's fall history, leading to an unwitnessed fall with head injury and pain.
    • AbuseFailed to properly plan care
    23 Apr 2023Abuse: Neglect
    Investigated a complaint and found neglect due to failure to plan care for a resident's fall history, resulting in an unwitnessed fall and injury.
    • AbuseFailed to properly plan care
    04 Apr 2023Abuse: Neglect
    Found a substantiated neglect and abuse allegation due to failing to provide a safe environment. A $375 fine was assessed.
    • AbuseFailed to provide safe environment
    02 Apr 2023Abuse: Neglect
    Found failure to provide a safe environment, resulting in a resident being hit and experiencing pain during a resident-to-resident altercation.
    • AbuseFailed to provide safe environment
    23 Mar 2023License Condition
    Investigated an allegation that ABST was not used; found failure to fully implement and update ABST as required.
    • Regulatory ActionFailed to use an ABST
    07 Feb 2023Complaint
    Identified deficiencies related to acuity-based staffing that could affect resident care.
    • DeficiencyLicensing Complaint Investigation
    • DeficiencyAcuity-Based Staffing Tool
    05 Jan 2023Abuse: Neglect
    Found a failure to provide a safe environment, resulting in harm and constituting abuse and neglect.
    • AbuseFailed to provide safe environment
    06 Dec 2022Licensure
    Identified deficiencies in kitchen sanitation and administration during the initial review. Determined substantial compliance on follow-up.
    • DeficiencyComment
    • DeficiencyResident Services Meals, Food Sanitation Rule
    • DeficiencyAdministration Compliance
    27 Nov 2022Inspection
    Investigated a physical abuse protection allegation; sustained against AP2, while the related organization-level claim had no finding.
    • LicensingFailed to protect resident from physical abuse
    27 Nov 2022Inspection
    Investigated an allegation of abuse and determined that a staff member used improper lifting techniques, causing arm pain to a resident, and that protections against abuse were not maintained.
    • LicensingFailed to protect resident from physical abuse
    13 Nov 2022Abuse: Neglect
    Found a failure to provide a safe environment resulting in a resident injury from a resident-to-resident incident, with a fine assessed.
    • AbuseFailed to provide safe environment
    13 Nov 2022Abuse: Neglect
    Investigated an allegation of failing to provide a safe environment; found that two residents had a physical altercation due to unsafe conditions, constituting abuse and neglect.
    • AbuseFailed to provide safe environment
    05 Nov 2022Abuse: Neglect
    Found deficiencies in care planning and interventions related to a resident's fall history, leading to a fall with injury and discomfort.
    • AbuseFailed to properly plan care
    05 Nov 2022Abuse: Neglect
    Found a failure to provide a safe environment that resulted in a resident's fall requiring hospital treatment; a $750 fine was assessed.
    • AbuseFailed to provide safe environment
    02 Oct 2022Abuse: Neglect
    Investigated and found a failure to implement interventions and an appropriate care plan for a resident's fall history, resulting in pain and discomfort; a $500 fine was assessed.
    • AbuseFailed to properly plan care
    30 Sept 2022Abuse: Neglect
    Found failure to implement interventions and appropriately plan care for a resident's fall history, resulting in injury and discomfort. This substantiated finding noted neglect and abuse.
    • AbuseFailed to properly plan care
    29 Sept 2022Abuse: Neglect
    Investigated an allegation of abuse and neglect related to a failure to provide a safe environment; found a violation and assessed a $375 fine.
    • AbuseFailed to provide safe environment
    28 Sept 2022Inspection
    Found violations related to unsafe medication administration and resident rights, including a miscount of controlled medications and neglect with potential financial abuse.
    • LicensingFailed to provide a safe medication administration system
    27 Sept 2022Abuse: Neglect
    Found deficiencies in fall-related care planning and interventions, resulting in an unwitnessed fall with head injury and neglect. A $450 fine was assessed.
    • AbuseFailed to properly plan care
    11 Sept 2022Abuse: Neglect
    Found that a safe environment was not provided, constituting abuse and neglect; a $375 fine was assessed.
    • AbuseFailed to provide safe environment
    03 Aug 2022Abuse: Neglect
    Determined that a safe environment was not provided for a resident, constituting abuse and neglect. A fine was assessed.
    • AbuseFailed to provide safe environment
    03 Aug 2022Abuse: Neglect
    Investigated a complaint and found the provider failed to ensure a safe environment for a resident. This constituted neglect and abuse.
    • AbuseFailed to provide safe environment
    27 Jun 2022Abuse: Neglect
    Found a failure to provide a safe environment resulting in a resident-to-resident altercation; a $500 fine was assessed.
    • AbuseFailed to provide safe environment
    26 Jun 2022Abuse: Neglect
    Found failure to provide a safe environment, constituting neglect and abuse. The finding notes a history of resident-to-resident altercations and risk to residents.
    • AbuseFailed to provide safe environment
    09 May 2022Abuse: Neglect
    Found violations for the provider failing to provide a safe environment; a $375 fine was assessed.
    • AbuseFailed to provide safe environment
    02 May 2022Abuse: Neglect
    Investigated a complaint about safety and resident harm; found a failure to provide a safe environment that led to a resident fracture after a resident-to-resident incident.
    • AbuseFailed to provide safe environment
    19 Apr 2022Abuse: Neglect
    Determined that fall-intervention care planning was inadequate, leading to repeated injuries. A $500 fine was assessed.
    • AbuseFailed to properly plan care
    10 Apr 2022Abuse: Neglect
    Found failure to provide a safe environment, leading to a resident fall with potential serious harm and classed as neglect and abuse.
    • AbuseFailed to provide safe environment
    26 Feb 2022Abuse: Neglect
    Investigated a fall-history care-planning failure that caused injuries and discomfort; a fine was assessed.
    • AbuseFailed to properly plan care
    04 Feb 2022Abuse: Neglect
    Found that care planning for a resident’s falls history was inadequate, leading to multiple falls with injury.
    • AbuseFailed to properly plan care
    02 Feb 2022Abuse: Neglect
    Found neglect due to inadequate care planning for a resident with elopement history, resulting in injury after leaving the secured area.
    • AbuseFailed to properly plan care
    12 Dec 2021Abuse: Neglect
    Investigated an allegation of neglect related to a resident's fall history and found failures to plan and implement appropriate interventions, resulting in injury and discomfort; a $250 fine was assessed.
    • AbuseFailed to properly plan care
    02 Oct 2021Abuse: Neglect
    Investigated and found a failure to provide a safe environment, constituting abuse and neglect.
    • AbuseFailed to provide safe environment
    02 Sept 2021Abuse: Neglect
    Determined neglect and abuse for failing to intervene when a resident's condition changed, resulting in hospital transport.
    • AbuseFailed to intervene when resident's condition changed
    11 Aug 2021Abuse: Neglect
    Investigated a complaint about safety and care planning. Found failures to provide a safe environment and to appropriately care plan for a resident who eloped and sustained injuries, constituting abuse and neglect.
    • AbuseFailed to provide safe environment
    09 May 2021Abuse: Neglect
    Investigated the allegation and found failure to follow the care plan led to a fall and hip fracture. A $2,500 fine was assessed for neglect and abuse.
    • AbuseFailed to follow care plan
    16 Apr 2021Abuse: Neglect
    Found a failure to follow a resident's care plan that caused a fall and discomfort, constituting neglect and abuse.
    • AbuseFailed to follow care plan
    08 Jan 2021Inspection
    Found a deficiency in the medication administration system that placed a resident at risk of harm.
    • LicensingFailed to provide a safe medication administration system
    31 Dec 2020Abuse: Neglect
    Identified neglect and abuse due to failure to implement interventions and care planning, leading to a physical altercation and a fine.
    • AbuseFailed to provide safe environment
    31 Dec 2020Abuse: Neglect
    Identified a failure to provide a safe environment that led to a resident altercation and discomfort, indicating neglect and abuse. A $338 fine was assessed.
    • AbuseFailed to provide safe environment
    28 Dec 2020Abuse: Neglect
    Found that a failure to provide a safe environment led to a physical altercation and harm, constituting abuse and neglect; a $338.00 fine was assessed.
    • AbuseFailed to provide safe environment
    29 Nov 2020Abuse: Neglect
    Found neglect and abuse from failing to follow the care plan, which led to an injury; a $338 fine was assessed.
    • AbuseFailed to properly plan care
    21 Nov 2020Abuse: Neglect
    Identified failures to implement interventions and follow the care plan, resulting in an unwitnessed fall with injury. This was classified as abuse and neglect.
    • AbuseFailed to follow care plan
    05 Oct 2020Abuse: Neglect
    Investigated allegations found failure to implement interventions and follow the resident’s care plan, leading to a fall and hospital admission with a cervical fracture. A fine was assessed.
    • AbuseFailed to follow care plan
    27 Sept 2020Abuse: Neglect
    Identified failure to provide appropriate supervision that allowed an elopement and risk of serious harm.
    • AbuseFailed to provide safe environment
    18 Sept 2020Inspection
    Found violations involving failure to follow the resident's care plan to prevent falls, leading to an unwitnessed fall and risk of harm.
    • LicensingFailed to assure resident was safe
    14 Sept 2020Abuse: Neglect
    Found failure to follow the fall-prevention care plan, resulting in a resident fall and head injury.
    • AbuseFailed to follow care plan
    19 Jul 2020Inspection
    Investigated and found that a door alarm or call system was not maintained, which could threaten residents' health and safety.
    • LicensingFailed to maintain functional door alarm or call system
    25 May 2020Inspection
    Determined that a staff member used profanity toward a resident and the facility failed to protect the resident from verbal abuse.
    • LicensingFailed to protect resident from verbal abuse
    23 May 2020Abuse: Neglect
    Found neglect of care resulting in serious harm due to delays in medical treatment after a fall. A $2,500 fine was assessed.
    • AbuseFailed to assure timely medical treatment
    16 May 2020Abuse: Neglect
    Investigated the allegation and concluded neglect occurred, resulting in an unwitnessed altercation and injury.
    • AbuseFailed to provide safe environment
    12 May 2020Abuse: Neglect
    Investigated an allegation of abuse and neglect and found failures to monitor a resident according to known behaviors, leading to an altercation and neglect. A $375 fine was assessed.
    • AbuseFailed to provide safe environment
    26 Apr 2020Abuse: Neglect
    Investigated an allegation of abuse/neglect and found failure to monitor per care plans led to a physical altercation and unreasonable discomfort.
    • AbuseFailed to provide safe environment
    01 Apr 2020Abuse: Neglect
    Investigated a complaint and found neglect and abuse due to failing to keep a resident in line of sight, leading to an unwitnessed altercation and injury; a $375 fine was assessed.
    • AbuseFailed to provide safe environment
    17 Mar 2020Abuse: Neglect
    Found that inadequate care planning around a fall history led to an unwitnessed fall and a wrist fracture, constituting neglect and abuse.
    • AbuseFailed to properly plan care
    05 Mar 2020Abuse: Neglect
    Found that one-on-one care per the care plan was not provided, resulting in an altercation and injury to a resident; a fine was assessed.
    • AbuseFailed to follow care plan
    30 Jan 2020Abuse: Neglect
    Investigated allegation of neglect and abuse due to failure to plan care, resulting in an unwitnessed fall and discomfort.
    • AbuseFailed to properly plan care
    26 Jan 2020Abuse: Neglect
    Investigated the allegation of neglect and abuse; found failure to follow the care plan led to a physical altercation and violation of resident rights.
    • AbuseFailed to provide safe environment
    06 Jan 2020Abuse: Neglect
    Found that failure to follow the care plan led to multiple falls and discomfort, constituting neglect and abuse; a $338 fine was assessed.
    • AbuseFailed to properly plan care
    06 Jan 2020Inspection
    Investigated the allegation of a failure to provide a safe environment and found substantiated that substantial compliance was not maintained.
    • LicensingFailed to provide safe environment
    18 Sept 2019Abuse: Neglect
    Found a failure to provide a safe environment that resulted in abuse and neglect, including an altercation and resident discomfort; a fine was assessed.
    • AbuseFailed to provide safe environment
    22 Aug 2019Abuse: Neglect
    Investigated a complaint and found neglect of basic care and supervision resulting in harm to a resident; a $375 fine was assessed.
    • AbuseFailed to provide safe environment
    19 Jul 2019Abuse: Neglect
    Investigated an abuse/neglect allegation and found neglect, resulting in bruising to a resident due to failure to provide basic care; a fine was assessed.
    • AbuseFailed to provide safe environment
    15 Jun 2019Abuse: Neglect
    Investigated the allegation of neglect and found a failure to provide a safe environment resulting in injury.
    • AbuseFailed to provide safe environment
    14 Jun 2019Abuse: Neglect
    Investigated a complaint found neglect and abuse due to inadequate care planning, resulting in an injury; a fine was assessed.
    • AbuseFailed to provide safe environment
    03 Jun 2019Abuse: Neglect
    Identified neglect due to inadequate supervision, resulting in a resident being grabbed, shaken, pushed against a wall, and kicked.
    • AbuseFailed to provide safe environment
    26 May 2019Abuse: Neglect
    Investigated and found neglect due to failure to provide basic care and supervision, resulting in a resident’s fall and injury.
    • AbuseFailed to follow care plan
    16 May 2019Abuse: Neglect
    Investigated the neglect allegation and concluded basic care and supervision were not provided, resulting in harm to a resident; a $375 fine was assessed.
    • AbuseFailed to provide safe environment
    13 May 2019Abuse: Neglect
    Found neglect due to failure to provide basic care, resulting in a resident falling and sustaining injuries.
    • AbuseFailed to adequately care plan related to falls
    13 May 2019Inspection
    Concluded that a report of potential or suspected abuse was not reported as required and assessed a fine.
    • LicensingFailed to report potential or suspected abuse
    16 Apr 2019Inspection
    Found courtyard doors were kept locked during daytime, contrary to the applicable rule.
    • LicensingFailed to provide a homelike environment
    16 Apr 2019Inspection
    Investigated and found a privacy violation where residents' information was exposed in a common area.
    • LicensingFailed to assure resident rights
    16 Apr 2019Inspection
    Found staffing was inadequate to meet 24-hour care needs and no system existed to respond to those needs.
    • LicensingFailed to provide appropriate staffing
    16 Apr 2019Inspection
    Found deficiencies in medication administration oversight and orders not carried out as prescribed due to staffing issues.
    • LicensingFailed to administer medication as ordered
    23 Jan 2019Abuse: Neglect
    Investigated a neglect allegation and found failure to supervise for safety that led to an incident where one resident hit another.
    • AbuseFailed to provide safe environment
    11 Dec 2018Inspection
    Identified a minor licensing violation for failing to address a resident's behavior, with a $500 fine assessed.
    • LicensingFailed to address resident's behavior
    24 Nov 2018Abuse: Neglect
    Investigated and found neglect due to inadequate supervision that resulted in harm to a resident.
    • AbuseFailed to provide safe environment
    30 Oct 2018Inspection
    Found neglect of resident safety, creating risk of serious harm; a fine was assessed.
    • LicensingFailed to address resident's behavior
    28 May 2018Abuse: Neglect
    Investigated an abuse/neglect allegation and substantiated that a safe environment was not provided, resulting in an assault.
    • AbuseFailed to address resident's behavior
    29 Apr 2018Inspection
    Found a failure to prevent a resident-to-resident altercation, resulting in a resident pushing another and a fall. A $500 fine was assessed.
    • LicensingFailed to follow care plan
    13 Apr 2018Inspection
    Investigated and found a deficiency in care that failed to provide a safe environment, resulting in residents hitting each other.
    • LicensingFailed to provide safe environment
    24 Feb 2018Inspection
    Investigated the allegation of an unsafe environment and found a deficiency in resident safety that contributed to an incident between residents.
    • LicensingFailed to provide safe environment
    23 Feb 2018Inspection
    Investigated and substantiated a care deficiency involving failure to assess and intervene on residents' needs, which led to a physical altercation between residents.
    • LicensingFailed to intervene when resident's condition changed
    04 Feb 2018Inspection
    Determined that the care plan was not followed, resulting in two residents leaving unattended.
    • LicensingFailed to follow care plan
    09 Oct 2017Inspection
    Investigated an allegation of failing to follow the care plan; found that residents were not kept safe from an altercation, resulting in one resident striking another with a butter knife.
    • LicensingFailed to follow care plan
    30 Sept 2017Inspection
    Investigated and found that care needs were not assessed or intervened, resulting in a resident slapping another.
    • LicensingFailed to follow care plan
    11 Aug 2017Inspection
    Investigated and found a safety deficiency that allowed a resident to elope from the site and walk several blocks.
    • LicensingFailed to provide safe environment
    11 May 2017Inspection
    Determined that a safety deficiency existed due to failure to assess and intervene on a resident's dining room care needs.
    • LicensingFailed to provide safe environment
    28 Feb 2017Abuse: Neglect
    Investigated an allegation of failure to provide a safe environment and found that a resident eloped, fell, and sustained a head injury due to safety lapses.
    • AbuseFailed to provide safe environment
    17 Dec 2016Abuse: Neglect
    Investigated a fall-related care planning allegation and found inadequate protection leading to hospitalization.
    • AbuseFailed to adequately care plan related to falls
    15 Dec 2016Inspection
    Investigated and identified a deficiency in protecting a resident from inappropriate verbal comments.
    • LicensingFailed to provide safe environment
    31 Oct 2015Abuse: Neglect
    Found substantiated abuse/neglect alleging failure to provide a safe environment due to inadequate assessment and intervention.
    • AbuseFailed to provide safe environment
    23 Oct 2015Inspection
    Investigated and found a failure to protect a resident from physical harm.
    • LicensingFailed to protect resident from rough treatment
    03 Jul 2015Abuse: Neglect
    Found a failure to provide a safe environment.
    • AbuseFailed to provide safe environment
    10 Oct 2014Abuse: Neglect
    Found a failure to ensure proper hydration. This resulted in a substantiated abuse/neglect finding.
    • AbuseFailed to assure proper hydration
    01 Oct 2014Abuse: Neglect
    Found that proper care was not provided; multiple regulatory violations were cited. A $300 fine was assessed.
    • AbuseFailed to provide service
    19 Sept 2014Abuse: Neglect
    Found a failure to provide a safe environment. A $300 fine was assessed.
    • AbuseFailed to provide safe environment
    19 Sept 2014Abuse: Neglect
    Investigated a neglect allegation and found failure to assess and intervene.
    • AbuseFailed to properly plan care
    04 Sept 2014Abuse: Neglect
    Found a failure to protect residents from sexually inappropriate activity.
    • AbuseFailed to protect resident from inappropriate sexual contact
    30 Jun 2014Abuse: Neglect
    Investigated the allegation of inadequate skin care and found a failure to assess and intervene.
    • AbuseFailed to provide appropriate skin care
    07 Jun 2014Inspection
    Investigated a records-related complaint and identified deficiencies in care planning and provision to meet needs.
    • LicensingFailed to properly plan care
    10 Jan 2014Abuse: Financial abuse
    Investigated and determined that residents' resources were misappropriated for another's gain.
    • AbuseFailed to protect resident from financial exploitation
    28 Aug 2013Inspection
    Identified deficiencies in care due to inadequate pain control.
    • LicensingFailed to provide appropriate pain control
    11 Dec 2012Inspection
    Investigated an allegation of not following the care plan and identified a failure to provide a safe environment.
    • LicensingFailed to follow care plan
    28 Nov 2012Inspection
    Found residents' safety not adequately addressed, with violations substantiated.
    • LicensingFailed to address resident's behavior
    26 Nov 2012Abuse: Financial abuse
    Found that a secure environment was not provided for RVs.
    • AbuseFailed to provide safe environment
    01 Nov 2012Abuse: Financial abuse
    Found that RV did not receive a safe environment.
    • AbuseFailed to provide safe environment
    25 Oct 2012Inspection
    Investigated and identified a safety deficiency related to failing to provide a safe environment.
    • LicensingFailed to address resident's behavior
    23 Oct 2012Inspection
    Identified a deficiency for failing to provide a safe environment for RVs.
    • LicensingFailed to address resident's behavior
    14 Sept 2012Abuse: Neglect
    Investigated the neglect allegation and found a safety deficiency due to failure to provide a safe environment.
    • AbuseFailed to address resident's behavior
    29 Aug 2012Abuse: Neglect
    Investigated an allegation of neglect and found a failure to provide a safe environment.
    • AbuseFailed to provide safe environment
    28 Aug 2012Abuse: Neglect
    Investigated an allegation of neglect and identified a failure to oversee and monitor changes in condition.
    • AbuseFailed to provide oversight and monitoring of change of condition
    01 Aug 2012Inspection
    Found that the program failed to address resident behavior and protect RVs.
    • LicensingFailed to address resident's behavior
    21 Jul 2012Abuse: Neglect
    Found that a safe environment was not maintained.
    • AbuseFailed to address resident's behavior
    21 Jul 2012Inspection
    Investigated an allegation of failure to report potential or suspected abuse and found that incidents between residents were not reported to the appropriate authorities.
    • LicensingFailed to report potential or suspected abuse
    21 Jun 2012Inspection
    Determined that a safe environment was not provided. The finding indicated a licensing violation with potential for moderate harm.
    • LicensingFailed to provide safe environment
    01 May 2012Inspection
    Found failure to provide a safe environment and proper care, with potential for minor to moderate harm.
    • LicensingFailed to provide safe environment
    01 May 2012Inspection
    Investigated an allegation of failing to administer medication as ordered and found improper medication management.
    • LicensingFailed to administer medication as ordered
    01 May 2012Inspection
    Found a deficiency in providing a secure environment that was substantiated.
    • LicensingFailed to provide safe environment
    10 Apr 2012Inspection
    Found a failure to provide a safe environment for residents.
    • LicensingFailed to provide safe environment
    08 Apr 2012Inspection
    Investigated an allegation that the resident's behavior was not addressed and found a safety deficiency in keeping the resident safe.
    • LicensingFailed to address resident's behavior
    29 Nov 2011Abuse: Neglect
    Identified improper care for residents' wounds after a fall.
    • AbuseFailed to perform adequate screening or assessment
    22 Sept 2011Abuse: Neglect
    Investigated the neglect allegation and substantiated it due to failure to follow the care plan, resulting in inadequate care for a resident.
    • AbuseFailed to follow care plan
    13 Apr 2011Inspection
    Found a failure to provide a safe environment.
    • LicensingFailed to provide safe environment
    20 Dec 2010Abuse: Neglect
    Found failure to provide a safe environment.
    • AbuseFailed to provide safe environment
    02 Dec 2010Abuse: Neglect
    Investigated a neglect allegation and found a failure to provide proper care and ensure safety for a resident.
    • AbuseFailed to assure resident was safe
    12 Sept 2010Abuse: Neglect
    Investigated an abuse/neglect allegation and found a failure to provide a safe environment.
    • AbuseFailed to follow care plan
    12 Aug 2010Inspection
    Found that a resident did not receive care per the care plan.
    • LicensingFailed to follow care plan
    10 Aug 2010Inspection
    Found an inadequate medication system.
    • LicensingFailed to administer medication as ordered

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