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Complaint Investigation

Avalon Care Center - Scappoose

Inspection Date: August 26, 2025
Total Violations 1
Facility ID 385283
Location SCAPPOOSE, OR
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Inspection Findings

F-Tag F0585

Resident Rights Deficiencies
Harm Level: Potential for More Than Minimal Harm

F 0585 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few

Honor the resident's right to voice grievances without discrimination or reprisal and the facility must establish a grievance policy and make prompt efforts to resolve grievances.

Based on interview and record review it was determined the facility failed to honor a grievance resolution for 1 of 3 residents (#401) reviewed for grievances. This placed residents at risk of not having their preferences honored regarding ADL care. Findings include:Resident 401 was admitted to the facility in 3/2025 with diagnoses including dementia and a femur fracture.A 3/30/25 admission MDS indicated Resident 401 had significant cognitive impairments.A 6/19/25 Grievance Form revealed concerns of Staff 4 (CNA) forcing Witness 1 (Power of Attorney) to leave Resident 401's room when care was provided. When Witness 1 requested to remain present, Staff 4 was reported to have stormed out of the room. A request was made by Witness 1 for Staff 4 to no longer provide care to Resident 401.A 6/24/25 Grievance Summary Report completed by Staff 2 (DNS) revealed the resolution was for Staff 4 to no longer provide care to Resident 401.Review of the 6/2025 and 7/2025 Documentation Survey Reports revealed Staff 4 provided ADL care which included brief changes, oral hygiene and/or showers to Resident 401 on 6/25, 6/27, 7/2, 7/3, 7/4, 7/5, 7/16 and 7/22.Review of vital tracking records during 6/2025 and 7/2025 revealed Staff 4 assessed Resident 4's vitals on 6/25 and 7/22. A 7/23/25 Interdisciplinary Team Care Plan Conference Quarterly

Review included comments from Witness 1 ensuring Staff 4 did not provide care to Resident 401.On 8/26/25 at 12:18 PM ADL care and vital records from 6/2025 and 7/2025 were reviewed with Staff 4. Staff 4 acknowledged her initials were were recorded as having provided care to Resident 401 on 6/25, 6/27, 7/2, 7/3, 7/4, 7/5, 7/16 and 7/22. On 8/26/25 at 2:23 PM Witness 1 stated she/he visited Resident 401 on 7/16/25 and observed Staff 4 providing one on one care to Resident 401. Witness 1 stated she/he reported her/his concerns regarding Staff 4 not providing care to Resident 401 on 7/16/25 and again during a care conference on 7/23/25.On 8/26/25 at 2:40 PM Staff 2 was informed Staff 4 continued to provide care to Resident 401 after the grievance was addressed. Staff 2 did not provide any additional information. Staff 2 confirmed records showed Staff 4 continued to provide care to Resident 401 following the resolution of the grievance.

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 REPRESENTATIVE'S SIGNATURE

TITLE

(X6) DATE

FORM CMS-2567 (02/99) Previous Versions Obsolete

Facility ID:

If continuation sheet

Event ID:

📋 Inspection Summary

AVALON CARE CENTER - SCAPPOOSE in SCAPPOOSE, OR inspection on recent inspection.

Found 0 violation(s). Severity: Standard violations. Status: 0 corrected, 0 pending.

What this means: Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. All deficiencies must be corrected within required timeframes and are subject to follow-up verification.

Frequently Asked Questions

What is an F-tag violation?
F-tags are federal deficiency codes used by CMS to categorize nursing home violations. Each F-tag corresponds to a specific federal regulation (42 CFR Part 483). For example, F607 relates to abuse prevention policies, F880 relates to infection control.
Were these violations corrected?
Facilities must submit plans of correction and implement changes within required timeframes. CMS conducts follow-up inspections to verify corrections. Check the inspection report for specific correction dates and follow-up verification status.
How often do nursing home inspections happen?
CMS conducts unannounced inspections of all Medicare/Medicaid-certified nursing homes at least once per year. Additional inspections may occur based on complaints, facility-reported incidents, or follow-up to verify previous violations were corrected.
What should families do about these violations?
Families should: (1) Review the full inspection report for details, (2) Ask facility administration about specific corrective actions taken, (3) Check if this represents a pattern by reviewing prior inspections, (4) Compare with other facilities in SCAPPOOSE, OR, (5) Report new concerns to state authorities.
Where can I see the full inspection report?
Complete inspection reports are available on Medicare.gov's Care Compare website (www.medicare.gov/care-compare). You can also request copies directly from AVALON CARE CENTER - SCAPPOOSE or from the state Department of Health. Reports include deficiency codes, facility responses, and correction timelines.
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