Footsteps at Greer Gardens

Last inspection

October 21, 2025

Inspections

8, 17 deficiencies cited

Substantiated abuse

14

Substantiated licensing violations

16

Regulatory actions

0

Fines assessed

$5,134.00 (14 violations)

Current owner since

July 25, 2017

Inspections

• October 21, 2025: Kitchen, 2 deficiencies cited report
  • C0240: Resident Services Meals, Food Sanitation Rule severity level 2, scope L2 Widespread
  • Z0142: Administration Compliance severity level 2, scope L2 Widespread
• March 13, 2025: Re-Licensure, 5 deficiencies cited report
  • C0231: Reporting & Investigating Abuse-Other Action severity level 2, scope L2 Isolated
  • C0360: Staffing Requirements and Training: Staffing severity level 2, scope L2 Widespread
  • C0422: Fire and Life Safety: Training for Residents severity level 2, scope L2 Pattern
  • Z0142: Administration Compliance severity level 2, scope L2 Widespread
  • Z0155: Staff Training Requirements severity level 2, scope L2 Pattern
• October 9, 2024: Kitchen, 3 deficiencies cited report
  • C0240: Resident Services Meals, Food Sanitation Rule severity level 2, scope L2 Widespread
  • C0370: Staffing Requirements and Training ? Pre-service severity level 2, scope L2 Pattern
  • Z0142: Administration Compliance severity level 2, scope L2 Widespread
• September 6, 2023: Complaint Investig., 1 deficiency cited report
  • C0010: Licensing Complaint Investigation severity level 2, scope L2 Isolated
  • C0361: Acuity-Based Staffing Tool severity level 2, scope L2 Widespread
• July 25, 2023: State Licensure, 2 deficiencies cited report
  • C0000: Comment severity level 0
  • C0240: Resident Services Meals, Food Sanitation Rule severity level 2, scope L2 Widespread, corrected November 20, 2023
  • C0455: Inspections and Investigation: Insp Interval severity level 0, corrected November 20, 2023
  • Z0142: Administration Compliance severity level 2, scope L2 Widespread, corrected November 20, 2023

Substantiated abuse or neglect

• August 17, 2025: Failed to properly plan care Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $338.00; 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

  The Alleged Victim (AV) is a known elopement risk and had a history of leaving his/her previous home. AV was moved into the facility without documentation from the prior facility. On or about August 17, 2025, AV left the secure facility and was gone for approximately 8 hours before staff realized AV was missing. A local resident contacted law enforcement about a person in their back yard, and when law enforcement arrived, it was discovered to be AV. Although AV was not harmed, AV was placed at risk of serious harm. Respondent failed to ensure proper care planning regarding AV's history of elopment. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(ii).

• June 21, 2025: Failed to follow care plan Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $375.00; 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

  According to the documentation, the facility failed to follow the service plan to always keep eyes on Witness 1 (W1) when they are in common areas. On or about June 21, 2025, W1 was in a common area with the Alleged Victim (AV) when W1 hit the AV in the face. Staff intervened and redirected W1 and the AV immediately after the physical altercation. The AV experienced anxiety after being hit in the face. The facility failed to follow the care plan to keep eyes on W1 due to their history of physical altercations with other residents resulting in an altercation with the AV, which is a violation of resident rights, is considered neglect of care and constitutes abuse.

• April 5, 2025: Failed to follow care plan Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $375.00; 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

  According to the documentation, the facility failed to follow the care plan for Witness 1 (W1) and the Alleged Victim (AV) by not keeping them separated due to a history of altercations. The service plans for both AV and W1 instructed staff to keep both residents on opposite sides of the facility due to a history of altercations. On or about April 05, 2025, the AV and W1 engaged in a physical altercation where each resident exchanged physical attacks on each other. the failure to follow the care plans for the AV and W1 resulted in a physical altercation between the two residents, which is a violation of resident rights, is considered neglect of care and constitutes abuse.

• November 7, 2024: Failed to properly plan care 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); 411-054-0028 (Reporting and Investigating Abuse and Other Actions Affecting Resident Welfare); 411-054-0036 (Service Plan – General)
  State’s findings

  According to the documentation, the facility failed to implement appropriate fall interventions for the Alleged Victim’s (AV) known fall history. Alleged Perpetrator 2 (AP2) failed to provide assistance to the (AV) after they were seen on the floor with blood on their face. On or about November 07, 2024, the AP2 was passing medication and found the AV on the floor, their legs in the air and blood on their face drinking a beverage. The AP2 continued to pass medications and returned a few minutes later to aid the AV. Upon evaluation, the facility staff determined the AV needed medical attention and sent the AV to the ER. The AP2 failed to provide aid to the AV immediately when they found them on the floor, which is a violation of resident rights, is considered neglect of care and constitutes abuse. Review of the Av’s service plan showed interventions to prevent falls that was not appropriate for the AV. The facility failed to update the AV’s care plan with appropriate fall interventions for AV’s history of injury falls. The failure resulted in the AV experiencing a fall and sustaining a head injury which needed to be assessed at the hospital, which is a violation of resident rights, is considered neglect of care and constitutes abuse.

• October 30, 2024: Failed to provide safe environment Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $169.00; 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

  According to the documentation, the facility failed to implement interventions to prevent the Alleged Victim (AV) and Witness 1 (W1) from resident-to-resident altercations. On or about October 30, 2024, a physical altercation occurred between the AV and W1 when the AV tried to cover W1’s mouth to get them to stop whistling. W1 bit the thumb of the AV, causing pain and unreasonable discomfort. There was previous altercation between the two residents and the facility failed to implement interventions to prevent the altercations, which is a violation of resident rights, is considered neglect of care and constitutes abuse.

Substantiated licensing violations

• August 17, 2025: Failed to provide safe environment Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0036 (Service Plan – General)
  State’s findings

  The facility failed to ensure the implementation of services in accordance with OAR 411-054-0036(2)(g); Per a report of a serious event.

• August 17, 2025: Failed to provide safe environment Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0025 (Facility Administration)
  State’s findings

  The facility failed to exercise reasonable precautions against any condition that may threaten the health, safety, or welfare of residents in accordance with OAR 411-054-0025(4); per a report of a serious event.

• May 8, 2025: Failed to follow care plan Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  State’s findings

  According to the documentation, the Unknown Alleged Perpetrator 2 (AP2) failed to follow the care plan for the Alleged Victim (AV) which left bruises on the AV’s hands. On or about May 08, 2025, bruising was found on AV’s hands. The location of the bruises on the AV’s hands were determined to be from an improper transfer by the AP2. The failure to follow the care plan to safely transfer the AV is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to ensure staff were following the care plan, which is a violation of Oregon Administrative Rule.

• February 19, 2025: Failed to assure resident rights Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0105 (Inspections and Investigations)
  State’s findings

  The facility failed to make records available to the Department upon request 411-054-0105(1)(a).

• February 19, 2025: Failed to assure resident rights Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  State’s findings

  The facility failed to make records available to the Department upon request 411-054-0105(1)(a).

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 32 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.