Pacific Living Centers of Roseburg at Ramp

Last inspection

April 2, 2026

Inspections

11, 52 deficiencies cited

Substantiated abuse

6

Substantiated licensing violations

18

Regulatory actions

0

Fines assessed

$2,013.00 (6 violations)

Current owner since

May 1, 2023

Inspections

• April 2, 2026: Re-Licensure, 6 deficiencies cited report
  • C0231: Reporting & Investigating Abuse-Other Action severity level 2, scope L2 Isolated
  • C0242: Resident Services: Activities severity level 2, scope L2 Widespread
  • C0260: Service Plan: General severity level 2, scope L2 Isolated
  • C0310: Systems: Medication Administration severity level 2, scope L2 Isolated
  • Z0142: Administration Compliance severity level 2, scope L2 Widespread
  • Z0162: Compliance with Rules Health Care severity level 2, scope L2 Isolated
• February 13, 2026: 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
• June 10, 2025: Complaint Investig., 1 deficiency cited report
  • C0231: Reporting & Investigating Abuse-Other Action severity level 2, scope L2 Isolated
• March 13, 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
• April 8, 2024: Validation, 9 deficiencies cited report
  • C0000: Comment severity level 0
  • C0150: Facility Administration: Operation severity level 2, scope L2 Widespread, corrected June 10, 2024
  • C0260: Service Plan: General severity level 2, scope L2 Isolated, corrected June 10, 2024
  • C0262: Service Plan: Service Planning Team severity level 2, scope L2 Pattern, corrected June 10, 2024
  • C0305: Systems: Resident Right to Refuse severity level 2, scope L2 Isolated, corrected June 10, 2024
  • C0325: Systems: Self-Administration of Meds severity level 2, scope L2 Isolated, corrected June 10, 2024
  • C0420: Fire and Life Safety: Safety severity level 2, scope L2 Widespread, corrected June 10, 2024
  • C0422: Fire and Life Safety: Training For Residents severity level 2, scope L2 Widespread, corrected June 10, 2024
  • C0510: General Building Exterior severity level 2, scope L2 Widespread, corrected June 10, 2024
  • C0513: Doors, Walls, Elevators, Odors severity level 2, scope L2 Widespread, corrected June 10, 2024

Substantiated abuse or neglect

• October 22, 2025: 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) is dependent on the facility to meet his/her safety needs and has a history of wandering behavior. AV's care plan included interventions for wandering behaviors that instructed staff to observe AV's location in the community at all times. According to an investigation, on or about October 22, 2025, AV was found on the ground in the secured yard area. Staff observed an injury to AV's head, resulting in AV being sent to the emergency department for evaluation. The door alarm installed on the exit door was determined to not be working. The facility failed to ensure AV's service planned need for supervision was provided and service plan followed which is a violation of resident rights, is neglect of care which constitutes abuse.

• December 27, 2024: Failed to provide safe environment Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $188.00; 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)
  State’s findings

  The Alleged Victim (AV) relies on the facility for his/her care. Witness 1 (W1) and AV have a history of resident-to-resident altercations and are care planned to be supervised and re-directed as needed. AV is care-planned for staff to be aware of whereabouts at all times and monitored when interacting with W1. According to an investigation, on or about December 27, 2024, AV wandered into W1's room and staff observed W1 touching AV on the buttocks and pulling AV close to W1. The facility failed to protect AV from sexual abuse, which is a violation of resident’s rights, is neglect of care and constitutes abuse.

• October 18, 2023: Failed to provide service Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $250.00; report
  Rules: 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 facility failed to provide appropriate services and supervision according to the Alleged Victim's (AV) needs and directions in his/her care plan. The failure resulted in AV being sent to a medical appointment without a facility staff escort, placing him/her at risk of harm, which is a violation of resident rights, considered neglect of care and constitutes abuse.

• December 5, 2022: Failed to follow care plan Abuse: Neglect; Level 3 - Moderate harm or potential for serious harm; fine $500.00; report
  Rules: 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 facility failed to implement effective interventions and follow the Alleged Victim's care plan according to his/her history of falls. The failure resulted in AV experiencing multiple falls and sustaining a hip fracture, which is a violation of resident rights, is considered neglect of care and constitutes abuse.

• November 22, 2021: Failed to protect resident from verbal abuse 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 documentation, the Alleged Perpetrator 2 (AP2) used inappropriate language and made sexual comments in front of the Alleged Victim, making him/her uncomfortable in his/her own home. AP2's actions are considered verbal/emotional abuse. The facility failed to protect AV from inappropriate actions by staff, which is a violation of resident rights, is considered neglect of care and constitutes abuse.

• November 9, 2021: Failed to protect resident from financial exploitation Abuse: Neglect; Level 3 - Moderate harm or potential for serious harm; fine $450.00; 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 facility failed to protect the Alleged Victim (AV) from financial exploitation, when an unknown individual stole his/her bank card. The failure resulted in unauthorized charges exceeding $1000.00, and went undiscovered for approximately 6 months, which is a violation of resident rights, is considered neglect of care and constitutes abuse. AP2 is substantiated for financial exploitation.

Substantiated licensing violations

• June 29, 2024: Failed to report potential or suspected abuse Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0028 (Reporting and Investigating Abuse and Other Actions Affecting Resident Welfare)
  State’s findings

  The facility failed to immediately notify the local Department office, or the local AAA, of any incident of abuse or suspected abuse following a physical injury of unknown cause when an immediate facility investigation did not reasonably conclude and document that the physical injury was not the result of abuse. The facility’s failure is a violation of Oregon Administrative Rules.

• June 24, 2024: Failed to protect resident from physical abuse Licensing Violation; Level 2 - Minor harm or potential for moderate harm; 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)
  State’s findings

  According to documentation, the Alleged Perpetrator 2 used physical force while providing care to AV because AV was resisting care. AP2's actions are considered physical abuse. The facility failed to protect AV from physical abuse, which is a violation of Oregon Administrative Rules.

• July 7, 2023: Failed to follow care plan 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. An investigation determined this is a violation of Oregon Administrative Rules.

• February 8, 2023: Failed to provide safe environment Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0200 (Residential Care Facility Building Requirements)
  State’s findings

  The facility failed to keep interior materials and surfaces (e.g., floors, walls, roofs, ceilings, windows, and furniture) clean and and all equipment in good repair for the health, safety, and comfort of the residents, which is a violation of Oregon Administrative Rules.

• October 26, 2022: Failed to properly plan care 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 implement a service plan that reflect the resident's needs as identified in the evaluation, which is a violation of Oregon Administrative Rules.

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 30 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.