Cedar Crossings: Resident Left Without Glasses for Months - OR
The resident, identified in inspection records only as Resident 48, was admitted to the facility in 2025 with diabetes and hypertension. Her care plan documented a vision deficit and called for staff to ensure her glasses were clean, appropriate, and being worn. In December 2025, she saw an eye doctor for blurry vision in both eyes and cataracts. The doctor prescribed new glasses. They would ship, the visit note said, two weeks after payment was received.
Five months passed.
When a federal inspector spoke with Resident 48 on May 18, 2026, and again on May 21, the resident said she had seen the eye doctor in January and received a new prescription but still had no glasses. She said she could barely see out of the pair she currently wore. She had to get very close to the TV. She said she had been waiting months and did not know where her new glasses were.
Her physician visited on May 21. His progress note listed poor vision as one of her chief complaints. It noted the glasses had been ordered in January and not received. His plan: follow up on the eyeglasses.
That same morning, a social services director identified in inspection records as Staff 8 and a social services coordinator identified as Staff 9 explained to the inspector how the process was supposed to work. After an eye exam, the facility receives an invoice from the optometrist. Social services gives that invoice to the resident so they know what it will cost. Staff 8 said she had never received any invoice from the December 2025 exam. She acknowledged that no follow-up had been done.
The administrator, identified as Staff 1, provided the inspector with the invoice the following morning, May 22. She said it had just been received. She acknowledged the facility had not assisted Resident 48 in obtaining glasses in a timely manner.
That acknowledgment came the day the inspection ended.
The deficiency was cited at a level of minimal harm, the lowest tier in the federal rating system. Inspectors noted the failure placed residents at risk for increased visual deficits.
What the inspection record shows is a gap that stretched across at least five months, possibly longer. The December 2025 eye visit generated an invoice. That invoice did not reach the social services director. Nobody tracked it down. Nobody checked on the glasses. Nobody, based on the records reviewed, connected the care plan's directive to ensure appropriate glasses were being worn with the fact that new ones had been prescribed and never arrived.
Resident 48's physician documented her poor vision as a presenting complaint on May 21, 2026. The facility's response, according to his note, was to plan to follow up on the eyeglasses. The inspector arrived the next day. The administrator located the invoice that morning.
Resident 48, meanwhile, had spent months getting close to the television to see it.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Cedar Crossings from 2026-05-22 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: This article is based on inspection data downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases inspection reports in bulk; we publish the findings as documented by state surveyors in the official Form CMS-2567 Statement of Deficiencies.
Plan of correction: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to state survey agencies and those responses may not be reflected in CMS data at the time of publication. The absence of a plan of correction in our data does not mean one was not filed. Readers who want information about corrective steps taken are encouraged to contact the facility directly or their state survey agency.
Corrections may have occurred: Inspection reports reflect conditions observed on the date of the survey. Facilities may have implemented corrections, staffing changes, additional training, or other remediation since the report was issued. We report what CMS provides and encourage readers to seek current information from the facility.
Editorial process: Inspection findings are extracted from CMS source documents and synthesized using AI, reviewed for factual accuracy against the original report by our editorial team.
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Last verified: October 31, 2026 · Our methodology
CEDAR CROSSINGS in PORTLAND, OR was cited for violations during a health inspection on May 22, 2026.
The resident, identified in inspection records only as Resident 48, was admitted to the facility in 2025 with diabetes and hypertension.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.