Advocate Care

Last inspection

April 2, 2025

Inspections

5, 17 deficiencies cited

Substantiated abuse

3

Substantiated licensing violations

9

Regulatory actions

0

Fines assessed

$1,625.00 (3 violations)

Current owner since

April 27, 2015

Inspections

• April 2, 2025: Re-Licensure, 5 deficiencies cited report
  • C0270: Change of Condition and Monitoring severity level 2, scope L2 Pattern
  • C0280: Resident Health Services severity level 2, scope L2 Isolated
  • C0303: Systems: Treatment Orders severity level 2, scope L2 Pattern
  • C0330: Systems: Psychotropic Medication severity level 2, scope L2 Pattern
  • C0420: Fire and Life Safety: Safety severity level 2, scope L2 Widespread
• February 28, 2025: Complaint Investig., 2 deficiencies cited report
  • C0360: Staffing Requirements and Training: Staffing severity level 2, scope L2 Widespread
  • C0363: Acuity Based Staffing Tool - Updates & Plan severity level 2, scope L2 Widespread
• June 11, 2024: State Licensure, 1 deficiency cited report
  • C0000: Comment severity level 0
  • C0240: Resident Services Meals, Food Sanitation Rule severity level 2, scope L2 Widespread, corrected August 10, 2024
• June 7, 2023: State Licensure, 1 deficiency cited report
  • C0000: Comment severity level 0
  • C0240: Resident Services Meals, Food Sanitation Rule severity level 2, scope L2 Widespread, corrected August 6, 2023
• February 7, 2022: Validation, 8 deficiencies cited report
  • C0000: Comment severity level 0
  • C0160: Reasonable Precautions severity level 2, scope L2 Widespread, corrected September 17, 2022
  • C0260: Service Plan: General severity level 2, scope L2 Pattern, corrected September 17, 2022
  • C0310: Systems: Medication Administration severity level 2, scope L2 Pattern, corrected September 17, 2022
  • C0420: Fire and Life Safety: Safety severity level 2, scope L2 Widespread, corrected September 17, 2022
  Show all 10

  • C0455: Inspections and Investigation: Insp Interval severity level 2, scope L2 Widespread, corrected January 17, 2023
  • C0510: General Building Exterior severity level 2, scope L2 Widespread, corrected September 17, 2022
  • C0513: Doors, Walls, Elevators, Odors severity level 2, scope L2 Widespread, corrected January 17, 2023
  • C0540: Heating and Ventilation severity level 2, scope L2 Widespread, corrected September 17, 2022
  • C0555: Call Sys, Exit Dr Alarm, Phones, Tv, Or Cable severity level 2, scope L2 Widespread, corrected September 17, 2022

Substantiated abuse or neglect

• March 19, 2024: Failed to provide safe environment Abuse: Neglect; Level 3 - Moderate harm or potential for serious harm; fine $1,125.00; report
  Rules: 411-054-0025 (Facility Administration); 411-054-0027 (Resident Rights and Protections)
  State’s findings

  The Alleged Victim (AV) has a history of behaviors. W4 is known to be easily triggered and has a history of verbal and aggressive behaviors. AV and W4 have been involved in a prior resident-to-resident incident with each other, where W4 hit AV in the head with his/her cane. According to an investigation, on or about March 19, 2024, W4 was passing by AV's door and AV said something derogatory toward W4. W4 entered AV's room and struck AV multiple times with W4's cane, resulting in AV being diagnosed with a fracture. The facility failed to provide a safe environment, which is which is a violation of resident rights, is neglect of care and constitutes abuse.

• January 6, 2024: Failed to follow care plan Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $250.00; report
  Rules: 411-054-0025 (Facility Administration); 411-054-0027 (Resident Rights and Protections); 411-054-0028 (Reporting and Investigating Abuse and Other Actions Affecting Resident Welfare); 411-054-0030 (Resident Services); 411-054-0036 (Service Plan – General)
  State’s findings

  Witness #2 (W2) has a history of altercations and is care planned for staff to monitor W2 when agitated. On or about January 6, 2024, W2 became agitated at the Alleged Victim (AV) while staff were attending to W2. Staff knew W2 was agitated and failed to follow the care plan to redirect and perform one to one engagement to alleviate altercations. When staff left W2, he/she engaged in an altercation with AV by throwing coffee, spitting on and punching AV. The facility's failure to follow the care plan is a violation of resident rights, is considered neglect of care and constitutes abuse.

• October 26, 2023: Failed to provide safe environment Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $250.00; report
  Rules: 411-054-0025 (Facility Administration); 411-054-0027 (Resident Rights and Protections); 411-054-0028 (Reporting and Investigating Abuse and Other Actions Affecting Resident Welfare); 411-054-0036 (Service Plan – General)
  State’s findings

  The Alleged Victim (AV) relies on the facility for his/her care. AV and W1 have aggressive behaviors and W1 is care planned for W1 to be separated from AV. According to an investigation, on or about October 26, 2023, AV coming down the hallway when W1 from punched AV in the face, resulting in a bruise and small lacerations on his/her face. The facility failed to provide a safe environment and follow W1’s care plan, which is a violation of resident rights, is neglect of care which constitutes abuse.

Substantiated licensing violations

• May 5, 2026: Failed to update staffing plan based on ABST Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0037 (Acuity-Based Staffing Tool)
  State’s findings

  The facility failed to fully implement and update an acuity-based staffing tool. The facility’s failure is a violation of Oregon Administrative Rules.

• May 9, 2025: Failed to staff as indicated by ABST Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0037 (Acuity-Based Staffing Tool)
  State’s findings

  The facility failed to develop, maintain, and implement an Acuity Based Staffing Tool. The facility’s failure is a violation of Oregon Administrative Rules

• April 20, 2025: Failed to staff as indicated by ABST Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0037 (Acuity-Based Staffing Tool)
  State’s findings

  The facility failed to develop, maintain, and implement an Acuity Based Staffing Tool. The facility’s failure is a violation of Oregon Administrative Rules.

• April 8, 2025: Failed to follow care plan Licensing Violation; Level 4 - Serious harm, death, imminent danger or chronic regulatory noncompliance; report
  Rules: 411-054-0036 (Service Plan – General)
  State’s findings

  Based on interview and record review, conducted during a site visit on 04/17/25, the facility’s failure to ensure the implementation of services for 1 of 1 sampled resident (# 1) was substantiated.

• April 8, 2025: Falsified records Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0025 (Facility Administration)
  State’s findings

  Based on interview and record review, conducted during a site visit on 04/17/25, the facility’s failure to develop and implement a written policy that prohibits the falsification of records was substantiated.

Read the full record on the state’s site →

ODHS lists only substantiated violations: “either a substantiated instance of abuse or a licensing violation. Open investigations and complaints that are being appealed by the provider are not listed.” Oregon counts neglect as a form of abuse; see the state’s definitions of abuse. Each violation shows the level ODHS gives it, in the state’s words (for example “2 - Minor harm or potential for moderate harm”), and any fine ODHS assessed. Inspection citations show the state’s severity level and scope, and the date ODHS recorded the problem as corrected when it lists one. Rule names come from the Oregon Administrative Rules. ODHS: “Formal regulatory actions can range from a condition placed upon a license due to non-compliance or a notice to revoke a license.” This community is licensed for 34 residents; larger communities are inspected and reported on more often, so read counts with size in mind. Source: Oregon Department of Human Services, Long-Term Care Licensing, data as of October 15, 2026, showing the last five years. Always visit in person and ask the community about anything listed here.