Marquis Tualatin Post Acute Rehab: Pain Care Failures - OR
The May 22 inspection at Marquis Tualatin Post Acute Rehab, a nursing facility at 19945 SW Boones Ferry Road, documented what multiple staff members then confirmed out loud: the resident had experienced nausea and vomiting every day since she was admitted, and the medication prescribed to treat it was not being given consistently.
Resident 31 is deaf. According to the inspection report, she communicated through gestures, pointing to her belly, her throat, her lower back, opening her mouth to signal distress. That morning, after finishing breakfast, she pointed to her stomach and grimaced. A certified nursing assistant, identified in the report as Staff 10, wheeled her back to her room. No one called the nurse. No anti-nausea medication was offered.
By 10:12 a.m., inspectors observed Resident 31 in her room pointing to her belly and lower back, coughing and gagging. She grabbed a bucket and vomited. Then she returned to bed and dry-heaved.
The medication that could have helped her, ondansetron, a prescription anti-nausea drug ordered on an as-needed basis, was finally administered at 10:24 a.m., after inspectors were already in the room watching.
When Staff 10 was interviewed at 10:32 a.m., she confirmed she had seen Resident 31 pointing to her belly and throat after breakfast. She said she did not report it to the nurse. She described communication with the resident as difficult because of her deafness, but she did not say she was unable to understand what the resident was signaling. She understood. She wheeled her back to her room and moved on.
The nurse on duty that morning, Staff 11, a licensed practical nurse, said Resident 31 depended entirely on staff to assess and address her needs each day. Staff 12, whose role is not specified in the report, said he was unaware the resident had daily nausea and vomiting. He said he was unaware she had been nauseous after breakfast that morning.
Staff 6, who had been Resident 31's nurse on the morning of May 19, three days earlier, acknowledged she had not given the resident her prescribed nausea medication that day either.
The facility's RN Resident Care Manager, Staff 3, told inspectors that staff did not consistently offer the ondansetron to address Resident 31's nausea and vomiting. That was the word she used: consistently. The resident had been nauseated every day since admission, the medication to treat it was prescribed and available, and staff were not giving it to her with any regularity.
The inspection report does not say how long Resident 31 had been a patient at the facility before the May 22 visit. It does not say whether anyone had flagged the pattern before inspectors arrived. What it records is a morning in which a woman who could not speak, who could only point and grimace and open her mouth and wait, vomited into a bucket while the people responsible for her care acknowledged, one after another, that this had been happening for days and that nobody had done much about it.
The deficiency was cited at a level of minimal harm or potential for actual harm, affecting a small number of residents. That is the lower end of the federal harm scale.
Resident 31 was still at the facility when the inspection concluded. The report does not say whether the nausea stopped.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Marquis Tualatin Post Acute Rehab 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.
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Last verified: October 31, 2026 · Our methodology
MARQUIS TUALATIN POST ACUTE REHAB in TUALATIN, OR was cited for violations during a health inspection on May 22, 2026.
According to the inspection report, she communicated through gestures, pointing to her belly, her throat, her lower back, opening her mouth to signal distress.
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.