Avalon Care Center - Scappoose

SNF/NF DUAL CERT
33910 E. Columbia Avenue, Scappoose, OR 97056

Facility Information

Facility ID 38E024
Status ACTIVE
County Columbia
Licensed Beds 40
Phone (503) 543-7131
Administrator Robert Mckenna
Active Date Jul 1, 2024
Owner Avalon Care Center - Scappoose, LLC
206 North 2100 W Ste 100
Salt Lake City UT 84116
Funding Medicaid, Medicare, Private Pay
Services:

No special services listed

10
Total Surveys
11
Total Deficiencies
0
Abuse Violations
10
Licensing Violations
0
Notices

Violations

Licensing: OR0002100700
Licensing: OR0002069600
Licensing: OR0002027700
Licensing: OR0001993800
Licensing: OR0001949200
Licensing: OR0001480800
Licensing: OR0001475304
Licensing: NAS18011
Licensing: CO17271
Licensing: NAS16094

Survey History

Survey 1D4EAE

1 Deficiencies
Date: 8/26/2025
Type: Complaint, Re-Licensure

Citations: 4

Citation #1: F0000 - INITIAL COMMENTS

Visit History:
1 Visit: 8/26/2025 | Corrected: 9/12/2025
2 Visit: 9/24/2025 | Corrected: 9/12/2025

Citation #2: F0585 - Grievances

Visit History:
1 Visit: 8/26/2025 | Corrected: 9/12/2025
2 Visit: 9/24/2025 | Corrected: 9/12/2025
Inspection Findings:
Resident 401 was admitted to the facility in 3/2025 with diagnoses including dementia and a femur fracture.A 3/30/25 Admission MDS indicated Resident 401 had significant cognitive impairments.A 6/19/25 Grievance Form revealed concerns of Staff 4 (CNA) forcing Witness 1 (Power of Attorney) to leave Resident 401's room when care was provided. When Witness 1 requested to remain present, Staff 4 was reported to have stormed out of the room. A request was made by Witness 1 for Staff 4 to no longer provide care to Resident 401.A 6/24/25 Grievance Summary Report completed by Staff 2 (DNS) revealed the resolution was for Staff 4 to no longer provide care to Resident 401.Review of the 6/2025 and 7/2025 Documentation Survey Reports revealed Staff 4 provided ADL care which included brief changes, oral hygiene and/or showers to Resident 401 on 6/25, 6/27, 7/2, 7/3, 7/4, 7/5, 7/16 and 7/22.Review of vital tracking records during 6/2025 and 7/2025 revealed Staff 4 assessed Resident 4GÇÖs vitals on 6/25 and 7/22.-áA 7/23/25 Interdisciplinary Team Care Plan Conference Quarterly Review included comments from Witness 1 ensuring Staff 4 did not provide care to Resident 401.On 8/26/25 at 12:18 PM ADL care and vital records from 6/2025 and 7/2025 were reviewed with Staff 4. Staff 4 acknowledged her initials were were recorded as having provided care to Resident 401 on 6/25, 6/27, 7/2, 7/3, 7/4, 7/5, 7/16 and 7/22.-áOn 8/26/25 at 2:23 PM Witness 1 stated she/he visited Resident 401 on 7/16/25 and observed Staff 4 providing one on one care to Resident 401. Witness 1 stated she/he reported her/his concerns regarding Staff 4 not providing care to Resident 401 on 7/16/25 and again during a care conference on 7/23/25.On 8/26/25 at 2:40 PM Staff 2 was informed Staff 4 continued to provide care to Resident 401 after the grievance was addressed. Staff 2 did not provide any additional information. Staff 2 confirmed records showed Staff 4 continued to provide care to Resident 401 following the resolution of the grievance.-á
Plan of Correction:
Immediate Correction: 





Staff number 4 was placed on administrative leave pending outcome of investigation and resigned from the company on 8/27/25.  Education on the grievance process done with IDT team, by Administrator. 





Identification of Others: 





A review of the last 30 days of grievances was completed by the Administrator to validate that resolutions are being followed. 





Systemic changes 





A new process for tracking staff assignments was put into place by the DNS and Scheduler. The length of time needed for point of care charting to automatically log a user out was adjusted to 15 minutes. Nursing staff were re-educated to ensure proper log out when moving away from a device and only charting on care delivered by them, not others. Open grievances will be reviewed at morning IDT meetings by administrator or designee until resolved. 





Ongoing Monitoring: 





Audits of point of care charting stations and tablets to ensure CNAs are properly logging out to be done by administrator or designee weekly for 4 weeks then monthly for two months. Audits of new staff assignment tracking process to be done weekly for 4 weeks, then monthly for two months by DNS or designee. Follow up with residents/representatives having filed a grievance to be completed by administrator one week after resolution to ensure resolutions are fully implemented and effective. Results of audits to be shared with the administrator and brought to QAPI monthly for 3 months for tracking, trending, and to ensure the process remains in compliance.

Citation #3: M0000 - Initial Comments

Visit History:
1 Visit: 8/26/2025 | Corrected: 9/12/2025
2 Visit: 9/24/2025 | Corrected: 9/12/2025

Citation #4: M9999 - STATE OF OREGON ADMINISTRATIVE RULES

Visit History:
1 Visit: 8/26/2025 | Corrected: 9/12/2025

Survey VKSG

0 Deficiencies
Date: 4/16/2025
Type: Complaint, Licensure Complaint, State Licensure

Citations: 2

Citation #1: F0000 - INITIAL COMMENTS

Visit History:
1 Visit: 4/16/2025 | Not Corrected

Citation #2: M0000 - Initial Comments

Visit History:
1 Visit: 4/16/2025 | Not Corrected

Survey M84E

5 Deficiencies
Date: 8/16/2024
Type: Complaint, Licensure Complaint, Re-Licensure, Recertification, State Licensure

Citations: 8

Citation #1: F0000 - INITIAL COMMENTS

Visit History:
1 Visit: 8/16/2024 | Not Corrected
2 Visit: 10/1/2024 | Not Corrected

Citation #2: F0656 - Develop/Implement Comprehensive Care Plan

Visit History:
1 Visit: 8/16/2024 | Corrected: 9/9/2024
2 Visit: 10/1/2024 | Not Corrected
Inspection Findings:
Based on observation, interview and record review it was determined the facility failed to implement a comprehensive person-centered care plan for 1 of 1 sampled resident (#24) reviewed for communication-sensory services. This placed residents at risk for decreased ability to communicate their wants and needs. Findings include:

Resident 24 was admitted to the facility in 6/2024 with diagnoses including aphasia (a language disorder that affects a person's ability to communicate) following non-traumatic subarachnoid hemorrhage (bleeding in the space between the brain and the surrounding membrane) and dysarthria (weakness in the muscles used for speech, causing slowed, slurred speech) following non-traumatic subarachnoid hemorrhage.

A review of Resident 24's 6/27/24 Admission MDS revealed she/he had adequate hearing but did not speak during the assessment.

On 8/13/24 at 9:31 AM Resident 24 was observed sitting up in bed. Her/his eyes were closed and she/he was awake. She/he did not speak when asked how she/he felt, but she/he gestured to a pool of saliva on her/his shirt.

A review of Resident 24's 6/20/24 care plan revealed she/he was at risk of impaired communication related to low tone of voice, post subarachnoid hemorrhage and "some cognitive impairment."

Resident 24's care plan revised on 6/28/24 indicated she/he was able to read written communication and had a picture board for communication kept at the nurses' station.

On 8/13/24 at 10:41 AM Resident 24 was observed in her/his room with a caregiver. Resident 24 did not communicate verbally with the caregiver and there was no evidence of a communication board in her/his room.

On 8/14/24 at 9:15 AM Staff 7 (CNA) reported Resident 24 nodded to indicate she/he understood but and used "weird facial expressions" to indicate she/he did not understand. Staff 7 stated staff did not have a communication board for Resident 24 and she thought, "it would be a great idea." She also stated, "I don't know if a board is in the works."

On 8/14/24 at 12:49 PM Staff 6 (Activities / Recreation Director) reported she was not aware of a communication board on Resident 24's care plan but she thought it would be a good tool for many departments to use when communicating with her/him.

On 8/14/24 at 1:21 PM Staff 6 reported she found the communication board at the nurses station "under a big pile of stuff" and stated "I didn't even know it was there. It's not specific for her. I don't know if she has ever used it."

On 8/14/24 at 1:30 PM Staff 1 (Administrator) acknowledged staff members were not using the communication board as instructed on Resident 24's care plan. He stated, "I expect that if it is on the care plan, the caregivers and nurses should be following it. There should be a copy of it for her in her room rather than just at the nurses station."
Plan of Correction:
F656 Develop/implement Comprehensive Care Plan CFR(s): 483.21 (b)(1)(3)



1. Resident #24 remains a resident in the facility. Communication board was placed in resident room and care plan was updated. Resident verbalized understanding and satisfaction.



2. DNS/designee audited resident communication care plans to ensure interventions are current and appropriate.



3. The facility will assess residents communication needs and preferences upon admission, during care conferences, and with change of condition, and develop and maintain a comprehensive care plan. Nursing staff received education regarding the identification of residents needing a communication board. Nursing staff were also educated on Resident Kardex, the location of communication devices, and usage with residents.



4. Unit manager/designee will audit new admissions and 5 random resident communication care plans weekly x 4 weeks, and then monthly for 2 months to ensure the communication care plans are appropriate. Audit findings will be brought to the administrator and reviewed at QAPI for further recommendations if indicated.



5. Date of Compliance 09/24/24

Citation #3: F0689 - Free of Accident Hazards/Supervision/Devices

Visit History:
1 Visit: 8/16/2024 | Not Corrected
Inspection Findings:
Based on interview and record review it was determined the facility failed to provide care in accordance with care planned interventions while pushing a resident in a wheelchair for 1 of 1 sampled resident (#1) reviewed for accidents. This failure resulted in an avoidable fracture to Resident 1's left ankle. Findings include:

Resident 1 was admitted to the facility in 2015 with diagnoses including dementia.

The 6/2023 Annual MDS revealed Resident 1 had a BIMS of 11 (moderate cognitive impairment).

Resident 1's mobility care plan dated 12/9/22 instructed staff to promote Resident 1's independence with locomotion as tolerated without leg rests and revealed Resident 1 needed assistance with leg rests in place for wheelchair mobility when being pushed by staff.

A 12/6/23 FRI report revealed on 12/3/23 Resident 1 mobilized her/himself independently while in her/his wheelchair from the dining room toward her/his room. Resident 1 became tired and Staff 11 (CNA) pushed Resident 1 towards her/his room. Staff 11 felt resistance while pushing Resident 1 and immediately stopped while Resident 1 yelled "Ow!" Staff 12 (LPN) was nearby and told Staff 11 to put Resident 1 into bed so he could look at Resident 1's ankle. Resident 1's ankle had a normal range of motion. Staff 12 administered medication for pain management and applied ice to the resident's ankle. Resident 1's physician was notified and staff were instructed to obtain an X-ray if the resident experienced increased pain or swelling. The FRI revealed Resident 1 had moderate pain and swelling to her/his left ankle, and 12/5/23 X-ray notes revealed she/he sustained an "...oblique [slanting] fracture involving the distal fibula [a prominent bone on outside of the ankle] with minimal callus [a temporary development that occurs at the site of a bone fracture and helps the bone move from the inflammatory phase to the repair phase] and mild displacement. The joint alignment is maintained. There is associated soft tissue swelling..." The resident was taken to the emergency department for an evaluation.

A 12/4/23 5:57 PM progress note by Staff 12 revealed Resident 1 was on alert charting, rested in bed, and her/his behavior was at baseline. Resident 1 stated her/his left ankle hurt when it was moved. The resident's left ankle was noted to be slightly swollen and tender, and she/he complained of pain twice during the shift. Staff 12 administered pain medication.

A 12/5/23 3:10 AM progress note by Staff 13 (LPN) revealed Resident 1's left ankle was swollen and painful to touch. The resident requested an ice pack for comfort which was effective.

A 12/5/23 10:15 PM progress note by Staff 14 (LPN) revealed a new physician's order was received for a left ankle X-ray to rule out a fracture.

A 12/6/23 1:54 AM progress note by Staff 15 (LPN) revealed X-ray results of Resident 1's left ankle found an oblique fracture with mild displacement and soft tissue swelling. Resident 1's physician was notified and orders were provided to offer ice packs and to send Resident 1 to the emergency department in the morning since the resident was stable and effective pain management was in place.

Resident 1's 12/6/23 hospital after visit summary and X-ray results revealed she/he had a left foot ankle fracture.

The facility obtained a follow up statement from Staff 11 on 12/6/23 at 9:00 AM. Staff 11 stated Resident 1 wheeled her/himself partway down a hall. Staff 11 assisted Resident 1 as she/he sounded out of breath and wanted to go to bed. As they approached the nurses station Resident 1 dropped her/his foot. Staff 11 felt resistance and stopped pushing the wheelchair. Resident 1 cried out and her/his ankle was assessed by another staff. Staff 11 was instructed to assist the resident back to her/his room. Staff 11 stated she then pushed Resident 1 very slowly and reminded her/him to hold her/his legs up. Staff 11 stated she knew how to access care plans and thought she reviewed Resident 1's care plan.

An untitled facility document dated 12/8/23 by Staff 16 (former DNS) revealed Staff 11 pushed Resident 1 in her/his wheelchair without leg rests which resulted in Resident 1's fractured left ankle. An interview with the resident found she/he felt safe and comfortable with Staff 11 continuing to provide care.

On 8/12/24 at 1:00 PM Resident 1 was observed self propelling slowly in her/his wheelchair with no leg rests.

During an interview on 8/12/24 at 2:46 PM Staff 12 stated he assessed the resident at the time of the incident and put ice on her/his foot because she/he complained of pain but there was no swelling or bruising at the time. He indicated the resident was able to identify pain appropriately. Staff 12 stated Resident 1 self propelled in her/his wheelchair independently but when she/he got tired staff placed leg rests on her/his wheelchair before pushing her/him.

On 8/13/24 at 10:47 AM Witness 1 (resident representative) stated she was informed of the 12/3/23 incident right away and believed it was a "pure accident." She added, Resident 1 would take the leg rests off her/his wheelchair or she/he would ask the staff to remove them. Witness 1 stated Resident 1 was pretty independent and liked to move her/his wheelchair on her/his own but when she/he got tired or was not feeling well she/he asked for help and staff would place the leg rests on the wheelchair before pushing her/him.

On 8/14/24 at 3:58 PM Staff 11 confirmed she pushed Resident 1 down the hallway to her/his room without the leg rests on her/his wheelchair, which resulted in Resident 1 sustaining a fractured ankle. Staff 11 stated the resident's foot was not swollen and had no bruising immediately after the accident.

On 8/15/24 at 7:18 PM Staff 15 confirmed the incident happened when she was not on shift but she did observe Resident 1's foot on 12/5/24. Staff 15 stated Resident 1 was placed on alert charting, was monitored every shift and received pain medication. Staff 15 stated she observed Resident 1's foot was swollen and the resident said it was slightly painful when she/he moved it. Staff 15 said the day shift nurse ordered the X-ray but she received the X-ray report. Since Resident 1 was stable at the time and it was the middle of the night, a physician's order was received for ice packs if Resident 1 needed it and the on-call doctor gave the okay to go to the hospital in the morning which allowed the resident to sleep. Staff 15 stated if Resident 1 was in a lot of pain she/he would have been sent to the emergency room sooner. Staff 15 added, she believed Resident 1 was care planned to have the footrests on the wheelchair when being pushed by staff before the incident happened and this hasn't happened again to her knowledge.

During an interview on 8/16/24 at 9:40 AM Staff 1 (Administrator), Staff 2 (DON), and Staff 3 (Regional Nurse Consultant) were informed of the findings of this investigation. They all confirmed the incident occurred.

On 12/8/23, the Past Noncompliance was corrected when the facility completed a root cause analysis of the incident and determined there was a failure to follow Resident 1's care plan to ensure leg rests were on her/his wheelchair before pushing her/him. The Plan of Correction included:

1. Staff education, for all staff, on placing leg rests onto resident wheelchairs, and how to look resident care plans and resident profiles.
2. A notice was created for Resident 1's wheelchair to remind staff to put the leg rests on her/his wheelchair before pushing her/him and what to do if Resident 1 declined the use of the leg rests.
3. Licensed nursing staff monitored use of leg rests on resident wheelchairs for residents who required assistance with mobilizing in wheelchairs.

Citation #4: F0804 - Nutritive Value/Appear, Palatable/Prefer Temp

Visit History:
1 Visit: 8/16/2024 | Corrected: 9/9/2024
2 Visit: 10/1/2024 | Not Corrected
Inspection Findings:
Based on observation, interview, and record review it was determined the facility failed to ensure proper food temperatures were maintained for meals served to residents on 3 of 3 halls reviewed for dining. This placed residents at risk for increased risk for impaired nutrition. Findings include:

Observation on 8/12/24 at 11:45 AM during tray pass Resident 1 complained of cold food.

Observation on 8/12/24 at 11:47 AM during tray pass Resident 4 complained of cold food.
Resident Council Meeting documentation from 5/2024 recorded residents complaints that breakfast was often cold.

On 8/14/24 at 3:37 PM Staff (5) Dietary Manager confirmed the residents had complained about cold food.

Twelve residents were interviewed during a Resident Council meeting on 8/15/24 at 10:21 AM. The residents complained about cold food on all halls.

On 8/15/24 at 2:51 PM the concern related to cold food was shared with Staff 1 (Administrator). No additional information was provided.
Plan of Correction:
F804 Nutritive Value/Appear, Palatable/Prefer Temp CFR(s): 483.60(d)(1)(2)



1. Resident #1 and #4 reside in the facility and have a grievance filed related to concerns with cold food. Residents educated to inform staff at mealtimes if the food temp is undesirable to allow for immediate correction in the kitchen. The Dietary Manager and Activities Director have met with the Resident Counsel to address the complaints about cold meals.



2. Facility residents have the potential to be affected by this practice.



3. The Dietary Manager/designee will order a plate warmer and insulated bases/covers to assist with maintainng proper food temperatures after plating. The dietary department will also order a tray cart cover for trays delivered to resident rooms to help maintain palatable food temperature.



Nursing and Dietary staff were educated on process related to returning and replacing trays if a resident voices concern related to food palatability/temperature.



4. The Dietary manager will conduct an audit of 10 random residents' weekly on food temperature x 1 month and then monthly x 2 months, along with monthly follow up in resident counsel. Audit findings will be brought to the administrator and reviewed at QAPI for further recommendations if indicated.



5. Date of Compliance 09/24/24

Citation #5: F0812 - Food Procurement,Store/Prepare/Serve-Sanitary

Visit History:
1 Visit: 8/16/2024 | Corrected: 9/9/2024
2 Visit: 10/1/2024 | Not Corrected
Inspection Findings:
Based on observation, interview, and record review it was determined the facility failed to monitor temperatures and cleanliness of 1 of 1 unit refrigerator. This placed the residents at risk for food-borne illness. Findings include:

The facility guideline for Dietary Service Resident Community Refrigerator stated:

-Housekeeping staff/designee will monitor the refrigerator daily for cleanliness. Concerns will be delegated to the designated department.

- Each refrigerator will have an approved thermometer inside the refrigerator. Designated staff will record the temperature at least daily.

On 8/14/24 at 12:48 PM the unit refrigerator used for resident snacks and personal foods was observed to have yellow liquid spilled on a lower shelf. There was no thermometer in the refrigerator.

On 8/14/24 at 12:49 PM Staff 5 (Dietary Manager) stated the cleaning and monitoring of unit
refridgerators was the responsibility of the kitchen staff. She confirmed the refridgerator
needed to be cleaned and no thermometer was present. She was not able to locate a temperature log for the refrigerator.
Plan of Correction:
F812 Food Procurement, Store/Prepare/Serve-Sanitary CFR(s): 483.60(i)(1)(2)



1. No residents were affected by this practice. The refrigerator was immediately cleaned, and the temperature log and thermometer were replaced to ensure proper resident refrigerator temperature tracking.



2. Current residents with food stored in identified refrigerator have the potential to be affected by this practice.



3. Dietary staff/designee will monitor the refrigerator daily for cleanliness. The Dietary Manager will in-service Dietary staff on the importance of maintaining the cleanliness of the refrigerator, maintaining the temperature log daily, and verifying presence of a working thermometer.



Nursing staff will be given an in-service to report to dietary if any cleanliness concerns are identified.



4. Dietary manager/ designee will audit refrigerator and refrigerator log weekly x 4 weeks and then monthly x 2 months to ensure cleanliness, and thermometer in place and temperature logs completed. Audit findings will be brought to the administrator and reviewed at QAPI for further recommendations if indicated.



5. Date of Compliance 09/24/24

Citation #6: M0000 - Initial Comments

Visit History:
1 Visit: 8/16/2024 | Not Corrected
2 Visit: 10/1/2024 | Not Corrected

Citation #7: M0182 - Nursing Services:Minimum Licensed Nurse Staff

Visit History:
1 Visit: 8/16/2024 | Corrected: 9/10/2024
2 Visit: 10/1/2024 | Not Corrected
Inspection Findings:
Based on interview and record review it was determined the facility failed to ensure an RN worked as the charge nurse for eight consecutive hours between the start of day shift and the end of evening shift for 47 of 134 days reviewed for RN coverage. This placed residents at risk for lack of RN oversight including resident care and services. Findings include:

A review of the Direct Care Staff Daily Reports from 1/1/24 through 3/31/24 and 7/1/24 through 8/12/24 revealed the following 47 days without an RN working for eight consecutive hours in the facility between the start of day shift and the end of evening shift:
-1/1/24 no RN worked on any shift;
-1/2/24 no RN worked on any shift;
-1/3/24 no RN worked on any shift;
-1/4/24 no RN worked on any shift;
-1/7/24 no RN worked on any shift;
-1/8/24 no RN worked on any shift;
-1/10/24 no RN worked on any shift;
-1/15/24 no RN worked on any shift;
-1/16/24 no RN worked on any shift;
-1/21/24 no RN worked on any shift;
-1/22/24 no RN worked on any shift;
-1/28/24 no RN worked on any shift;
-1/29/24 no RN worked on any shift;
-1/30/24 no RN worked on any shift;
-2/4/24 no RN worked on any shift;
-2/5/24 no RN worked on any shift;
-2/11/24 no RN worked on any shift;
-2/12/24 no RN worked on any shift;
-2/13/24 no RN worked on any shift;
-2/18/24 no RN worked on any shift;
-2/19/24 no RN worked on any shift;
-2/25/24 no RN worked on any shift;
-2/26/24 no RN worked on any shift;
-2/27/24 no RN worked on any shift;
-3/10/24 no RN worked on any shift;
-3/17/24 no RN worked on any shift;
-3/25/24 no RN worked on any shift;
-3/26/24 no RN worked on any shift;
-3/27/24 no RN worked on any shift;
-3/28/24 no RN worked on any shift;
-3/31/24 no RN worked on any shift;
-7/7/24 no RN worked on any shift;
-7/15/24 no RN worked on any shift;
-7/18/24 no RN worked on any shift;
-7/19/24 no RN worked on any shift;
-7/21/24 no RN worked on any shift;
-7/22/24 no RN worked on any shift;
-7/25/24 no RN worked on any shift;
-7/26/24 no RN worked on any shift;
-7/27/24 no RN worked on any shift;
-7/28/24 no RN worked on any shift;
-8/2/24 no RN worked on any shift;
-8/4/24 no RN worked on any shift;
-8/5/24 no RN worked on any shift;
-8/9/24 no RN worked on any shift;
-8/11/24 no RN worked on any shift; and
-8/12/24 no RN worked on any shift.

On 8/15/24 at 9:25 AM Staff 10 (Staffing Coordinator) acknowledged the days with insufficient RN staffing and stated, "It is absolutely our goal to have the RN shifts covered."

On 8/16/24 at 10:01 AM Staff 1 (Administrator) reported he was aware of multiple days not having the required RN coverage. He stated it was his goal to have all RN shifts covered.
Plan of Correction:
M182 OAR 411-086-0100(4) Nursing Services: Minimum Licensed Nurse Staff



1. No residents were affected by this practice.



2. All residents have the potential to be affected by this practice.



3. Avalon Care Center is currently in the process of sourcing adequate RN staff. Due to the rural area, recruitment has posed challenging, but center is dedicated to ongoing recruitment efforts. A sign on bonus has been implemented and wages have been increased to encourage increased applicant flow. Recruiters are actively sourcing for RN applicants. If an assigned RN is unable to cover shift or in-house replacement cannot be found to cover required RN hours, the shift will then be sent out to the 3 agencies that the facility is contracted with for coverage.



4. Administrator/ DNS/ Staffing Coordinator will have weekly meetings with corporate recruiter to discuss any open RN positions, and continued recruitment efforts to support coverage. Audit findings will be brought to the administrator and reviewed at QAPI for further recommendations if indicated.



5. 09/24/2024

Citation #8: M9999 - STATE OF OREGON ADMINISTRATIVE RULES

Visit History:
1 Visit: 8/16/2024 | Not Corrected
Inspection Findings:
***********************
411-086-0060    
Comprehensive Assessment and Care Plan

Refer to F656
***********************
411-086-0140    
Nursing Services: Problem Resolution & Preventive Care

Refer to F689
***********************
411-086-0250    
Dietary Services

Refer to F804, F812
***********************

Survey R7WT

0 Deficiencies
Date: 7/8/2024
Type: Complaint, Licensure Complaint, State Licensure

Citations: 2

Citation #1: F0000 - INITIAL COMMENTS

Visit History:
1 Visit: 7/8/2024 | Not Corrected

Citation #2: M0000 - Initial Comments

Visit History:
1 Visit: 7/8/2024 | Not Corrected

Survey KKNF

1 Deficiencies
Date: 10/17/2023
Type: Focused Infection Control, Other-Fed

Citations: 1

Citation #1: F0884 - Reporting - National Health Safety Network

Visit History:
1 Visit: 10/17/2023 | Not Corrected
Inspection Findings:
Based on record review, the facility failed to report complete information about COVID-19 to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) during a seven-day period that reporting was required by regulation.

The CDC submitted data from the NHSN to the Centers for Medicare and Medicaid Services (CMS). Based on review of that data, CMS determined that between 10/09/2023 and 10/15/2023, the facility did not report complete information to NHSN about COVID-19 in the standardized format and frequency as specified by CMS and the CDC. This failure to report has the potential to cause more than minimal harm to all residents residing in the facility.

Survey YSX5

1 Deficiencies
Date: 5/23/2023
Type: Focused Infection Control, Other-Fed

Citations: 1

Citation #1: F0884 - Reporting - National Health Safety Network

Visit History:
1 Visit: 5/23/2023 | Not Corrected
Inspection Findings:
Based on record review, the facility failed to report complete information about COVID-19 to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) during a seven-day period that reporting was required by regulation.

The CDC submitted data from the NHSN to the Centers for Medicare and Medicaid Services (CMS). Based on review of that data, CMS determined that between 05/15/2023 and 05/21/2023, the facility did not report complete information to NHSN about COVID-19 in the standardized format and frequency as specified by CMS and the CDC. This failure to report has the potential to cause more than minimal harm to all residents residing in the facility.

Survey 2T57

0 Deficiencies
Date: 5/22/2023
Type: Focused Infection Control, Other-Fed, Other-State, State Licensure

Citations: 3

Citation #1: E0000 - Initial Comments

Visit History:
1 Visit: 5/22/2023 | Not Corrected

Citation #2: F0000 - INITIAL COMMENTS

Visit History:
1 Visit: 5/22/2023 | Not Corrected

Citation #3: M0000 - Initial Comments

Visit History:
1 Visit: 5/22/2023 | Not Corrected

Survey WMK3

1 Deficiencies
Date: 8/8/2022
Type: Focused Infection Control, Other-Fed

Citations: 1

Citation #1: F0884 - Reporting - National Health Safety Network

Visit History:
1 Visit: 8/8/2022 | Not Corrected
Inspection Findings:
Based on record review, the facility failed to report complete information about COVID-19 to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) during a seven-day period that reporting was required by regulation.

The CDC submitted data from the NHSN to the Centers for Medicare and Medicaid Services (CMS). Based on review of that data, CMS determined that between 08/01/2022 and 08/07/2022, the facility did not report complete information to NHSN about COVID-19 in the standardized format and frequency as specified by CMS and the CDC. This failure to report has the potential to cause more than minimal harm to all residents residing in the facility.

Survey 1TLD

1 Deficiencies
Date: 9/20/2021
Type: Focused Infection Control, Other-Fed

Citations: 1

Citation #1: F0884 - Reporting - National Health Safety Network

Visit History:
1 Visit: 9/20/2021 | Not Corrected
Inspection Findings:
Based on record review, the facility failed to report complete information about COVID-19 to the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) during a seven-day period that reporting was required by regulation.

The CDC submitted data from the NHSN to the Centers for Medicare and Medicaid Services (CMS). Based on review of that data, CMS determined that between 09/13/2021 and 09/19/2021, the facility did not report complete information to NHSN about COVID-19 in the standardized format and frequency as specified by CMS and the CDC. This failure to report has the potential to cause more than minimal harm to all residents residing in the facility.

Survey K74E

1 Deficiencies
Date: 9/15/2021
Type: State Licensure

Citations: 2

Citation #1: M0000 - Initial Comments

Visit History:
1 Visit: 9/15/2021 | Not Corrected
2 Visit: 11/18/2021 | Not Corrected

Citation #2: M0183 - Nursing Services: Minimum CNA Staffing

Visit History:
1 Visit: 9/15/2021 | Corrected: 10/8/2021
2 Visit: 11/18/2021 | Not Corrected
Inspection Findings:
Based on interview and record review it was determined the facility failed to meet the minimum required CNA to resident staffing ratio for nine out of 14 night shifts reviewed. This placed residents at risk for unmet needs. Findings include:

Effective 8/24/21, temporary OAR 411-086-0100 allows for a minimum of one CNA per 18 residents on the night shift.

The Direct Care Staff Daily Reports from 9/1/21 through 9/14/21 reflected 64% of the night nights had CNA shortages.

On 9/15/21 at 10:30 AM Staff 1 (Administrator) confirmed the above CNA shortages.
Plan of Correction:
No residents were negatively affected by this deficient practice



All residents have the potential to be affected by this practice



The facility has agreed to pay more competitive rate to contracted staffing agency to help recruit additional Certified Nursing Assistants. The facility will continue to offer extra shift bonuses, and incentives to CNAs picking up extra shifts. Facility will continue to place on-line ads for CNAs with starting wage of $17/hr., keep offering $1500 sign on bonus and $250 referral bonus to current staff member



The Facility Administrator/Designee will review CNA staffing/schedule weekly to ensure the facility is meeting the minimum required CNA to resident staffing ratio per shift and no more than 25 percent of the nursing assistants assigned to residents per shift are uncertified nursing assistants.



The facility administrator will ensure compliance and will report findings to QAPI for 3 months