Saint Helens Post Acute
SAINT HELENS POST ACUTE in SAINT HELENS, OR — inspection on April 27, 2026.
Found 5 citations. 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
limited to receiving treatment and supports for daily living safely.
observation, interview and record review it was determined the facility failed to provide a comfortable
for an unsatisfying experience and living in an unkept environment.
Findings include:Resident 41 was admitted to the facility in 2025 with a diagnoses including anxiety.A 1/28/26 Quarterly MDS assessed Resident 41 as cognitively intact.On 4/19/26 at 10:26 AM room [ROOM NUMBER]'s floor appeared unwashed and dark spots around the toilet and throughout the bathroom.On 4/19/26 at 10:49 AM Resident 41 stated her/his room was not cleaned regularly and had not been cleaned since Friday (4/17/26) because the facility was often short staffed.On 4/19/26 at 10:53 AM Staff 19 (Director of Housekeeping) was the only housekeeping staff observed to work in the facility.
Staff 19 confirmed he was the only person working in housekeeping when the survey team entered on 4/19/26.On 4/19/26 at 10:59 AM the shared bathroom for room [ROOM NUMBER] was observed with dark stains in the toilet bowl.On 4/19/26 at 12:03 PM room [ROOM NUMBER] was observed with a dirty floor, debris spread throughout on the floor, dark stains in the toilet bowl and the bathroom smelled of urine.On 4/24/26 at 9:00 AM Staff 19 and Staff 20 (Regional Director of Housekeeping) walked throughout the facility with the surveyor.
Staff 19 acknowledged he had scrubbed the resident's toilet bowls on 4/21/26 due to the dark stains.
Staff 19 stated due to the older building some stains would not come off several surfaces.
Staff 19 and Staff 20 confirmed the following observations:-room [ROOM NUMBER] shared bathroom with dark substance on the toilet seat, handle and tank.-room [ROOM NUMBER] floor baseboards were unclean.-The resident shower rooms on 3 of 3 halls appeared unclean and unkept by items left in the room.On 7/26/23 at 1:12 PM Staff 1 (Administrator) walked through the facility with surveyor.
Staff 1 acknowledged he expected the residents' rooms and areas to be clean.
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.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER TITLE (X6) DATE REPRESENTATIVE'S SIGNATURE
385222 04/27/2026
Saint Helens Post Acute 75 Shore Drive Saint Helens, OR 97051
from the on-call provider for Resident 94's lorazepam for delivery as soon as possible and ideally
especially given Resident 94's diagnoses.
Staff 3 acknowledged there was no record of follow-up on
receive her/his requested dose of lorazepam the night of admission and did not receive her/his scheduled doses as ordered the following day.
385222 04/27/2026
Saint Helens Post Acute 75 Shore Drive Saint Helens, OR 97051
residents at risk for increased pain.
Findings include:Resident 94 was admitted to the facility in
pain), dorsalgia (back pain), anxiety disorder, panic disorder, and opioid dependence. Resident 94's 2/28/26 admission MDS indicated the resident was cognitively intact. Resident 94's 2/24/26 admission orders included the following:Hydrocodone-acetaminophen (an opioid pain reliever) 10 mg - 325 mg oral tablet, give 1 tabs every four hours as needed for pain.Resident 94's 2/2026 MAR indicated the following medication was ordered on 2/24/26 at 10:26 AM:- Hydrocodone-acetaminophen 10 mg - 325 mg oral tablet, give 1 tablet every four hours as needed for pain.- Hydrocodone-acetaminophen 10 mg - 325 mg oral tablet was first administered to the resident on 2/25/36 at 4:25 AM.On 4/21/26 at 1:01 PM Staff 33 (LPN) stated they did not recall Resident 94, the admission, or any issues related to the delivery of hydrocodone-acetaminophen.
Staff 33 was unable to provide additional information regarding whether the hydrocodone-acetaminophen prescription was sent to the pharmacy, or why there was a delay in delivery. No documentation by Staff 33 was identified in the medical record to clarify the events surrounding the hydrocodone-acetaminophen prescription and its delivery.On 4/21/26 at 6:26 PM Witness 7 (Complainant) stated Resident 94 was admitted to the facility around noon on 2/24/26.
Witness 7 stated the admitting nurse advised Resident 94's hydrocodone-acetaminophen would be delivered to the facility within a few hours of admission.
Witness 7 stated at approximately 2:30 AM on 2/25/26 Resident 94 called them in distress indicating she/he was in pain and needed hydrocodone-acetaminophen, and it was not available.
Witness 7 stated they contacted the facility, advised the nurse the resident needed pain medication and were told the hydrocodone-acetaminophen prescription had not been sent to the pharmacy. On 4/27/26 at 12:49 PM Staff 36 (CNA) stated Resident 94 was in pain on 2/25/26 and was agitated the night of admission to the facility and the resident requested pain medication several times which they reported to the nurse.
Staff 36 stated Resident 94 was upset because her/his hydrocodone-acetaminophen was not available when she/he was told it would be at the time of admission.
Staff 36 stated the resident also called Witness 7 twice and reported she/he was in pain and needed her pain medication and had not received it.
Staff 36 stated they were unsure what time Resident 94 began requesting pain medication but believed it was early in their shift, which began at 10:00 PM.On 4/22/26 at 5:24 PM Staff 37 (RN) stated the night of Resident 94's admission they received a call from Witness 7 requesting pain medication for the resident reporting she/he had called them from her/his room upset and in pain.
Staff 37 stated Resident 94 had admitted to the facility earlier that day with orders for hydrocodone-acetaminophen for pain control, but the prescription had not been sent to the pharmacy, and therefore resident's pain medication was not available for administration.
Staff 37 requested a prescription from the on-call provider and a pull-code (a code for secure access) from the pharmacy to access the facility's backup supply of hydrocodone-acetaminophen.
Staff 37 administered Resident 94 her/his first dose of hydrocodone-acetaminophen on 2/25/26 at 2:25 AM.On 4/24/26 at 10:35 AM Staff 3 (LPN-Resident Care Manager) and Staff 4 (RNCM) stated the resident was admitted to the facility from home without a hard copy of the hydrocodone-acetaminophen prescription.
Staff 4 stated in such cases the admitting nurse should have requested a STAT (immediate) prescription from the on-call provider for Resident 94's hydrocodone-acetaminophen for delivery as soon as possible and ideally within four hours.
Staff 3 and Staff 4 stated there should have been diligent follow-up by the floor nurse and documentation reflecting the cause of any delay and the status of the prescription delivery, especially given Resident 94's diagnoses.
Staff 3 acknowledged there was no record of follow-up on the hydrocodone-acetaminophen prescription in Resident 94's medical record and the medication was not readily available to the resident upon request.
385222 04/27/2026
Saint Helens Post Acute 75 Shore Drive Saint Helens, OR 97051
A review of the resident's clinical record revealed no evidence the PT order was acknowledged,
On 4/23/26 at 3:24 PM Staff 4 (RNCM) stated the order must have been missed.
She confirmed the
resident did not receive therapy services.
385222 04/27/2026
Saint Helens Post Acute 75 Shore Drive Saint Helens, OR 97051
risk for exposure to household pest and increased health risks.
Findings include: On 4/22/26 at 9:19
the facility. AT 9:24 AM Witness 9 stated he came to the facility one time per month per the contract.
Witness 9 stated he had not observed evidence of rodents in the facility but observed evidence of roaches for months.
Review of the Pest Control Log on 4/22/26 at 1:10 PM revealed sightings of roaches had been reported from 10/2025 to 4/2026.On 4/22/26 at 1:52 PM Witness 9 stated the facility really needed services for two applications per month for pest control to eradicate the roaches.On 4/22/26 at 1:54 PM Staff 1 (Administrator) Staff 1 acknowledged concerns with roaches throughout the facility.
Staff 1 stated he had asked Witness 9 to provide more service during his past and recent visits one time per month to control pests, especially roaches. On 4/23/26 at 12:11 PM and 4:45 PM Staff 43 (CNA) and Staff 44 (CNA) both reported sightings of roaches in the facility.
Staff 43 and Staff 44 stated sightings were not always written or reported in the Pest Control Log.On 4/24/26 at 8:13 AM Staff 27 (CNA) stated she had observed roaches in the facility and was unaware of a Pest Control Log to report sightings of pests.On 4/27/26 at 9:38 AM Staff 1 confirmed the ongoing issue of roaches, and he expected the facility to be pest free.
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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.