The Watermark at The Pearl

Last inspection

January 23, 2026

Inspections

2, 29 deficiencies cited

Substantiated abuse

2

Substantiated licensing violations

1

Regulatory actions

0

Fines assessed

$413.00 (2 violations)

Current owner since

February 6, 2024

Inspections

• January 23, 2026: Re-Licensure, 19 deficiencies cited report
  • C0231: Reporting & Investigating Abuse-Other Action severity level 2, scope L2 Pattern
  • C0260: Service Plan: General severity level 2, scope L2 Pattern
  • C0270: Change of Condition and Monitoring severity level 2, scope L2 Pattern
  • C0280: Resident Health Services severity level 2, scope L2 Isolated
  • C0282: RN Delegation and Teaching severity level 2, scope L2 Isolated
  Show all 19

  • C0290: Res Hlth Srvc: On- and Off-Site Health Srvc severity level 2, scope L2 Isolated
  • C0300: Systems: Medications and Treatments severity level 2, scope L2 Pattern
  • C0302: Systems: Tracking Control Substances severity level 2, scope L2 Pattern
  • C0340: Restraints and Supportive Devices severity level 2, scope L2 Pattern
  • C0363: Acuity Based Staffing Tool - Updates & Staffing Plan severity level 2, scope L2 Widespread
  • C0370: Staffing Requirements and Training ? Pre-service severity level 2, scope L2 Pattern
  • C0372: Training Within 30 Days of Hire ? Direct Care Staff severity level 2, scope L2 Pattern
  • C0420: Fire and Life Safety: Safety severity level 2, scope L2 Widespread
  • C0422: Fire and Life Safety: Training for Residents severity level 2, scope L2 Widespread
  • C0513: Doors, Walls, Elevators, Odors severity level 2, scope L2 Widespread
  • L0370: Staffing Requirements and Training ? Pre-service 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
  • Z0162: Compliance with Rules Health Care severity level 2, scope L2 Pattern
• August 12, 2024: Initial Licensure, 10 deficiencies cited report
  • C0000: Comment severity level 0
  • C0270: Change of Condition and Monitoring severity level 2, scope L2 Isolated, corrected October 14, 2024
  • C0280: Resident Health Services severity level 2, scope L2 Isolated, corrected October 14, 2024
  • C0300: Systems: Medications and Treatments severity level 2, scope L2 Pattern, corrected October 14, 2024
  • C0325: Systems: Self-Administration of Meds severity level 2, scope L2 Isolated, corrected October 14, 2024
  Show all 11

  • C0361: Acuity-Based Staffing Tool severity level 2, scope L2 Pattern, corrected October 14, 2024
  • C0420: Fire and Life Safety: Safety severity level 2, scope L2 Widespread, corrected October 14, 2024
  • C0511: General Building Interior severity level 2, scope L2 Pattern, corrected October 14, 2024
  • H1518: Individual Door Locks: Key Access severity level 2, scope L2 Pattern, corrected October 14, 2024
  • Z0142: Administration Compliance severity level 2, scope L2 Widespread, corrected October 14, 2024
  • Z0162: Compliance With Rules Health Care severity level 2, scope L2 Pattern, corrected October 14, 2024

Substantiated abuse or neglect

• February 24, 2026: Failed to provide oversight and monitoring of change of condition Abuse: Neglect; Level 2 - Minor harm or potential for moderate harm; fine $225.00; 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); 411-054-0055 (Medications and Treatments)
  State’s findings

  The Alleged Victim (AV) relies on the facility for medication and treatment management. The AV required weight monitoring and had specific parameters for reporting weight changes to the AV's provider to direct medication adjustment. According to an investigation, on multiple occasions the AVs weight was documented as meeting the parameter for reporting to the medical provider as ordered. There was no evidence the increase in weight was reported, placing the AV at risk of medical complications. On March 16th, 2026, the AV's medical provider adjusted a medication dosage. The new dosage was not initiated until March 19th, 2026, and the medication was not administered on March 18th, 2026, placing the AV at risk of medical complications. The allegation that Alleged Perpetrator failed to follow medical orders was investigated and determined to be not substantiated. The facility failed to follow medial orders and administer medication as ordered for the AV, which is a violation of resident’s rights, is neglect of care, and constitutes abuse.

• November 27, 2025: Failed to properly plan care 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); 411-054-0036 (Service Plan – General); 411-054-0055 (Medications and Treatments)
  State’s findings

  The Alleged Victim (AV) has a history of falls and relies on the facility to manage their medications. According to an investigation, the AV fell three times between November 27, 2025, and January 3, 2026, resulting in bruising, abrasions, and requiring an emergency room visit and staples to the head. The AV is prescribed a medication to reduce fluid retention. The facility failed to re-order the medication. The medication was not administered between January 8, 2026, to January 11, 2026, resulting in pain, discomfort, and requiring a hospital stay for treatment of the fluid retention. The facility failed to appropriately care plan for the AV's falls and to administer the AV's medications as ordered, which is a violation of resident’s rights, is neglect of care, and constitutes abuse

Substantiated licensing violations

• July 2, 2026: Failed to assure a qualified caregiver was present Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0070 (Staffing Requirements and Training)
  State’s findings

  Based on record review, interviews, and observations, the facility failed to provide a training program that includes methods to determine competency of direct care staff through evaluation, observation, or written testing. The facility’s failure 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 109 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.