Cascade Terrace Post Acute
CASCADE TERRACE POST ACUTE in PORTLAND, OR — inspection on December 26, 2025.
Found 1 citation. Severity: Standard violations.
Health inspections identify deficiencies that facilities must correct within required timeframes. Violations range from minor documentation issues to serious safety concerns and are subject to follow-up verification.
Inspection Findings
Based on interview and record review it was determined the facility failed to ensure physician orders were followed for 1 of 3 sampled residents (#1) reviewed for medication.
This placed residents at risk for adverse medication side effects.
Findings include:Resident 1 admitted to the facility in 2025 with diagnoses including obesity and diabetes.
The 9/23/25 physician order indicated Resident 1 was to receive semaglutide (Ozempic) injection once weekly.On 12/23/25 at 11:47 AM, Resident 1 stated that she/he missed several doses of Ozempic due to the medication not being ordered. A review of Resident 1's 10/2025, 11/2025 and 12/2025 MARs and TARs indicated she/he did not receive semaglutide on the following dates:-12/16/25-10/30/25-10/23/25-10/16/25-10/9/25-10/2/25Resident 1's Progress Notes indicated that Staff 2 (LPN) administered medication to Resident 1 on 10/2/25, 10/9/25, 10/16/25, 10/23/25 and 10/30/25, but did not administer semaglutide for the following reasons: medication was not filled last week, a new order was needed, the prescription had ended, the resident requested a prescription, or the notes were left blank.On 12/23/25 at 1:19 PM, a message was left for Staff 2. A return call was not received.On 12/23/25 at 2:31 PM, Staff 3 (LPN) stated she did not administer Ozempic on 12/16/25 because she thought it had to be refrigerated and she was not aware it was kept in the medication cart once opened. On 12/23/25 at 2:52 PM, Staff 1 (DNS) acknowledged Resident 1 did not receive semaglutide as ordered on the identified dates.
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the date of survey whether or not a plan of correction is provided.
For nursing homes, the above findings and plans of correction are disclosable 14 days following the date these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
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Source: This inspection report was downloaded directly from the Centers for Medicare & Medicaid Services (CMS) via Medicare.gov. CMS releases nursing home inspection reports in bulk. The findings reflect what state surveyors documented in the official Form CMS-2567 Statement of Deficiencies on the date of the inspection.
Plan of correction not included: The CMS report we receive does not include the facility's plan of correction. Facilities submit plans of correction separately to their state survey agency and those responses may not appear in CMS public data at the time of release. The absence of a plan of correction in this report does not mean one was not filed. Readers who want information about corrective steps taken by the facility are encouraged to contact the facility or their state survey agency directly.
Corrections may have been made: This report reflects conditions observed on the date of the survey. The facility may have implemented staffing changes, additional training, policy revisions, or other corrective actions since this report was issued. We publish what CMS provides and encourage readers to seek current information from the facility.