Garden Home Care LLC

Adult Foster Home (Class 2)
8150 SW 80TH AVE, PORTLAND, OR 97223

Facility Information

Facility ID 5017331995
Status Active
County Washington
Licensed Beds 5
Phone 5037195933
Email [email protected]
Administrator N/A
Active Date Apr 6, 2023
Funding Private Pay
Services:

No special services listed

3
Total Surveys
6
Total Deficiencies
0
Abuse Violations
1
Licensing Violations
0
Notices

Violations

Licensing: CALMS - 00057585

Survey History

Survey RL004036

1 Deficiencies
Date: 4/22/2025
Type: Re-Licensure

Citations: 1

Citation #1: V5942 - Limited: Supportive Devices

Visit History:
t Visit: 4/22/2025 | Corrected: 4/22/2025
Regulation:
OAR 411-049-0150(21)(l) Limited: Supportive Devices

(l) The licensee must install or make available, any supportive device necessary to meet the resident's needs and ensure resident safety including, but not limited to, grab bars, ramps, and door alarms.
Inspection Findings:
During scheduled renewal inspection it was found that a grab bar is needed near the garage door on the inside to help residents enter and exit the garage safely since you need to step down into the garage.
Plan of Correction:
Technical Assistance Provided. Written plan of correction not required.

Survey 4VA8

5 Deficiencies
Date: 5/24/2024
Type: Validation, Re-Licensure

Citations: 6

Citation #1: V0000 - Initial Comments

Visit History:
1 Visit: 5/24/2024 | Not Corrected
Inspection Findings:
Adult Foster Homes must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of a scheduled onsite inspection for renewal conducted on 05/24/2024. The adult foster home was evaluated for compliance with Oregon Administrative Rule 411, Divisions 049, 050, 051, and 052. The following deficiencies were identified:

Citation #2: V7052 - Resident Care: Activities

Visit History:
1 Visit: 5/24/2024 | Not Corrected
Inspection Findings:
Based on observation, interview and record review, it was determined the licensee failed to meet this rule as evidenced by: Activities for the residents were not documented until 3/25/24.Statement of Correction due by 6/13/24
Plan of Correction:
Provider statement recieved 6/13/24 as written:"Actions taken to correct deficiency: Activities are currently being documented and have been as of 3/25/24 for all residents.Actions taken to identify other residents affected by the deficiency: Staff will continue to document as per rules so that all residents will continue to have documented activities. Action taken to ensure the deficiency will no occur again: Staff has been trained to continue documenting. New activity forms were made to clarify."Statement of Correction accepted by KN on 6/14/24

Citation #3: V7222 - Medication: Changed Orders

Visit History:
1 Visit: 5/24/2024 | Not Corrected
Inspection Findings:
Based on observation, interview and record review, it was determined the licensee failed to meet this rule as evidenced by: Resident #2 had a PRN medication with an order for one dosage amount but pharmacy label and MAR had a different dosage amount.Provider received copy of order from the pharmacy stating that it was okay to use the specific dosage listed on the pharmacy and MAR.Statement of Correction due by 6/13/24.
Plan of Correction:
Provider statement recieved 6/13/24 as written:"Actions taken to correct deficiency: Staff corrected the deficiency by ensuring the order matches the prescription, MAR and the PRN parameters.Actions taken to identify other residents affected by the deficiency: Staff will continue to monitor and review all orders for each resident. Action take to ensure the deficiency will not occur again: Staff put in place a correction system that provides copies of the doctors orders, PRN parameters and MAR. All records are input into the correction system to ensure our order matches the MAR and PRN. Then lastly you will check that the medication indeed matched the order.The date deficiency was corrected: 05/24/24"Statement of Correction accepted by KN on 6/14/24

Citation #4: V7223 - Medication: Changed Orders Attempts

Visit History:
1 Visit: 5/24/2024 | Not Corrected
Inspection Findings:
Based on observation, interview and record review, it was determined the licensee failed to meet this rule as evidenced by: Resident #3 was missing a doctor order for a PRN medication.Statement of Correction and verification due by 6/13/24
Plan of Correction:
Provider statement recieved 6/13/24 as written:"Action taken to correct deficiency: Staff contacted resident #3 primary care physicians and got an updated order for the PRN. Staff then ensured the PRN, MAR and Medication matched the order.Actions taken to identify other residents affected by the deficiency: Staff trained to better monitor orders for all residents in care. Action take to ensure the deficiency will not occur again: Staff put in place a correction system that provides copies of the doctors orders, PRN parameters and MAR. All records are input into the correction system to ensure our order matches the MAR and PRN. Then lastly you will check that the medication indeed matches the order. Copies of the entire medication list will be sent out every 6 months for a new signature.The date deficiency was corrected 6/10/24"Verification not received. Statement will be accepted once verification is recieved.Statement of Correction not accepted by KN on 6/14/24

Citation #5: V7231 - Mars: Missed Or Refused

Visit History:
1 Visit: 5/24/2024 | Not Corrected
Inspection Findings:
Based on observation, interview and record review, it was determined the licensee failed to meet this rule as evidenced by: Resident #2 had two routine medications that were initialed and crossed out on 3/6/24 and 2/5/24. There was no documentation on the back of the MAR. Initials were not circled. On 3/22/24, there was a PRN medication that were initialed and crossed out. Initials were not circled and nothing was documented on the back of the MAR.Statement of Correction due by 6/13/24
Plan of Correction:
Provider statement recieved 6/13/24 as written:"Actions taken to correct deficiency: Staff corrected the mistake on the MAR.Actions taken to identify other residents affected by the deficiency: Staff understands the mistake and has been trained on the proper way to document an error.Action take to ensure the deficiency will not occur again: Staff was trained on the proper way to document an initial error. Resident manager will take six classes to review medication administration documentation. The date deficiency was corrected 5/31/24Statement of Correction accepted by KN on 6/14/24

Citation #6: V7233 - Mars: Prn Medication: Documentation

Visit History:
1 Visit: 5/24/2024 | Not Corrected
Inspection Findings:
Based on observation, interview and record review, it was determined the licensee failed to meet this rule as evidenced by: Resident #1 had a PRN medication which was initialed on the front of the MAR but missing the documentation onthe back of the MAR.Statement of Correction due by 6/13/24
Plan of Correction:
Provider statement received 6/13/24 as written:"Actions taken to correct deficiency: Staff corrected medication in the MAR with proper documentation.Actions taken to identify other residents affected by the deficiency: MAR was reviewed for all residents.Action take to ensure the deficiency will not occur again: Staff was trained to review MAR daily for deficiencies and will take six rights class to ensure proper documentation of medication. The date deficiency was corrected 5/31/24Statement of correction accepted by KN on 6/14/24

Survey MXKW

0 Deficiencies
Date: 3/28/2023
Type: Validation, Initial Licensure

Citations: 1

Citation #1: V0000 - Initial Comments

Visit History:
1 Visit: 3/28/2023 | Not Corrected
Inspection Findings:
Adult Foster Homes must operate and provide services in compliance with all applicable State and local laws, regulations and codes. This report reflects the findings of the scheduled on-site inspection for initial licensure on 03/28/2023. The adult foster home was evaluated for compliance with Oregon Administrative Rule 411, Divisions 049, 050, 051, and 052. The following technical assists were identified:

Data sourced from Oregon Long-Term Care Licensing

Report generated: 2025-12-12T14:40:30.712Z