Allegiance Senior Care LLC

Adult Foster Home (Class 3)
9925 SW 82ND AVE, PORTLAND, OR 97223

Facility Information

Facility ID 6723008771
Status Active
County Washington
Licensed Beds 5
Phone 5032464116
Email [email protected]
Administrator Michele Nixon
Active Date May 22, 2019
Funding Private Pay
Services:

No special services listed

5
Total Surveys
2
Total Deficiencies
0
Abuse Violations
2
Licensing Violations
0
Notices

Violations

Licensing: 00066616-AP-048187
Licensing: CO19300

Survey History

Survey RL004673

2 Deficiencies
Date: 5/27/2025
Type: Re-Licensure

Citations: 2

Citation #1: V5755 - Training: HCBS After April 2024

Visit History:
t Visit: 5/27/2025 | Corrected: 6/23/2025
Regulation:
OAR 411-049-0125(2)(f)(B) Training: HCBS After April 2024

(f) HOME AND COMMUNITY-BASED SERVICES (HCBS) TRAINING. All caregivers, including licensees, administrators, resident managers, floating resident managers, shift caregivers or substitute caregivers are required to complete the Department-approved HCBS training, as provided below:
(B) All new caregivers, hired on or after April 1, 2024, must complete the required training prior to beginning job responsibilities.
Inspection Findings:
During scheduled renewal inspection it was found that caregivers #2, and #3 had not completed their annual HCBS training. It's been more than a year since the first training was taken.
Plan of Correction:
Statement of Correction Written as Received:

1. All staff did their yearly HCBS class
2. HCBS due dates for each staff have been added to [REDACTED] monthly audit sheet.
3. Deficiency was corrected by 5-29-25

Citation #2: V5942 - Limited: Supportive Devices

Visit History:
t Visit: 5/27/2025 | Corrected: 6/12/2025
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 in the garage since there is a step down to the ground. A grab bar is needed so that the garage can be accessible for residents.
Plan of Correction:
Technical Assistance Provided. Written plan of correction not required. However, verification of correction will be needed.

Survey B74Q

0 Deficiencies
Date: 7/25/2024
Type: Validation, Re-Licensure

Citations: 1

Citation #1: V0000 - Initial Comments

Visit History:
1 Visit: 7/25/2024 | 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 the scheduled on-site, renewal inspection conducted on 07/25/2024. The adult foster home was evaluated for compliance with Oregon Administrative Rule 411, Divisions 049, 050, 051, and 052. The adult foster home was found to be in substantial compliance.

Survey 2MZ1

0 Deficiencies
Date: 8/10/2023
Type: Validation, Re-Licensure

Citations: 1

Citation #1: V0000 - Initial Comments

Visit History:
1 Visit: 8/10/2023 | 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, renewal inspection conducted on 08/10/2023. The adult foster home was evaluated for compliance with Oregon Administrative Rule 411, Divisions 049, 050, 051, and 052. The adult foster home was found to be in substantial compliance.

Survey DRX2

0 Deficiencies
Date: 5/16/2022
Type: Validation

Citations: 1

Citation #1: V0000 - Initial Comments

Visit History:
1 Visit: 5/16/2022 | 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 on-site, renewal inspection conducted on 05/16/2022. The adult foster home was evaluated for compliance with Oregon Administrative Rule 411, Divisions 049, 050, 051, and 052. The adult foster home was found to be in substantial compliance.

Survey 61MZ

0 Deficiencies
Date: 4/9/2021
Type: Validation, Re-Licensure

Citations: 1

Citation #1: V0000 - Initial Comments

Visit History:
1 Visit: 4/9/2021 | 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 virtual renewal inspection conducted on 04/09/2021. The adult foster home was evaluated for compliance with Oregon Administrative Rule 411, Divisions 049, 050, 051, and 052. The adult foster home was found to be in substantial compliance.

Data sourced from Oregon Long-Term Care Licensing

Report generated: 2025-12-12T15:14:52.868Z