Trustwell Living at Rogue River Place

Last inspection

August 20, 2026

Inspections

2, 20 deficiencies cited

Substantiated abuse

2

Substantiated licensing violations

5

Regulatory actions

0

Fines assessed

$1,126.00 (4 violations)

Current owner since

September 30, 2024

Inspections

• August 20, 2026: Re-Licensure, 13 deficiencies cited report
  • C0154: Facility Administration: Policy & Procedure severity level 2, scope L2 Widespread
  • C0260: Service Plan: General severity level 2, scope L2 Pattern
  • C0282: RN Delegation and Teaching severity level 2, scope L2 Isolated
  • C0303: Systems: Treatment Orders severity level 2, scope L2 Pattern
  • C0310: Systems: Medication Administration severity level 2, scope L2 Pattern
  Show all 13

  • C0362: Acuity Based Staffing Tool - ABST Time severity level 2, scope L2 Isolated
  • C0363: Acuity Based Staffing Tool - Updates & Staffing Plan severity level 2, scope L2 Isolated
  • 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
  • C0610: General Building Exterior severity level 2, scope L2 Widespread
  • L0370: Staffing Requirements and Training ? Pre-service severity level 2, scope L2 Pattern
• June 25, 2025: Re-Licensure, 7 deficiencies cited report
  • C0240: Resident Services Meals, Food Sanitation Rule severity level 2, scope L2 Widespread
  • C0270: Change of Condition and Monitoring severity level 2, scope L2 Pattern
  • C0330: Systems: Psychotropic Medication severity level 2, scope L2 Pattern
  • C0340: Restraints and Supportive Devices severity level 2, scope L2 Isolated
  • C0372: Training Within 30 Days of Hire ? Direct Care Staff severity level 2, scope L2 Pattern
  • C0610: General Building Exterior severity level 2, scope L2 Widespread
  • C0613: General Building: Doors-Walls, Cleanable severity level 2, scope L2 Widespread

Substantiated abuse or neglect

• March 16, 2026: 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)
  State’s findings

  The Alleged Victim (AV) relies on the facility for his/her care and has a history of falls. According to an investigation, the AV had documented falls on March 6, 2026, resulting in a skin tear, and March 8, 2026. On or about March 11, 2026, the AV fell and was identified to have a head injury. The facility failed to appropriately service plan and implement reasonable interventions to address AV’s ongoing falls, which is a violation of resident rights, is considered neglect of care, and constitutes abuse.

• November 29, 2024: Failed to properly plan care Abuse: Neglect; Level 3 - Moderate harm or potential for serious 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

  The Alleged Victim (AV) is a known fall risk with a history of falls. According to an investigation, the AV experienced approximately eleven falls between October 9, 2024, and November 29, 2024, resulting in pain, a, skin tear, and unreasonable discomfort. The facility failed to care plan according to AV's needs to mitigate the risk of falls, resulting in harm, which is a violation of resident rights, is neglect of care, and constitutes abuse.

Substantiated licensing violations

• March 29, 2026: Failed to use an ABST Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0037 (Acuity-Based Staffing Tool)
  State’s findings

  Based on interview and record review, the facility failed to complete, or update and review the Acuity-Based Staffing Tool (ABST) evaluation for each resident quarterly as required. The facility’s failure is a violation of Oregon Administrative Rules.

• March 16, 2026: Failed to protect resident from financial exploitation Licensing Violation; 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 to manage their medications. According to an investigation, on or about March 17, 2026, it was identified that an unknown Alleged Perpetrator had replaced the AV's narcotic pain medication with an over-the-counter medication. The AV experienced no negative outcome. The AP2's actions are a violation of resident rights, considered financial exploitation and constitutes abuse.

• December 30, 2025: Failed to use an ABST Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0037 (Acuity-Based Staffing Tool)
  State’s findings

  Based on interview and record review, the facility failed to complete, or update and review the Acuity-Based Staffing Tool (ABST) evaluation for each resident quarterly as required. The facility’s failure is a violation of Oregon Administrative Rules.

• November 29, 2024: Failed to assist with toileting Licensing Violation; 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)
  State’s findings

  The Alleged Victim (AV) is a fall risk, has a history of falls and is known to self-transfer without calling for assistance. According to an investigation, on or about November 29, 2024, the AV requested assistance to the restroom from the Alleged Perpetrator 2 (APS). The AP2 did not assist the AV to the bathroom. The AV self-transferred and was found on the floor. AP2’s actions are a violation of resident rights, are considered neglect of care, and constitutes abuse. The facility did not keep the AV free from neglect, which is a violation of Oregon Administrative rules.

• March 11, 2022: Failed to protect resident from physical abuse Licensing Violation; Level 2 - Minor harm or potential for moderate harm; report
  Rules: 411-054-0027 (Resident Rights and Protections); 411-054-0028 (Reporting and Investigating Abuse and Other Actions Affecting Resident Welfare)
  State’s findings

  Alleged Victim (AV) relies on the facility for his/her care. On or about March 11, 2022, AV accused Alleged Perpetrator 2 (AP2) of pushing him/her hard against the wall while changing his/her briefs. AP2 would tell AV to “go against the wall” and then AP2 would push AV against the wall, which would hurt AV. AP2 failed to protect AV from physical abuse, which is a violation of which is neglect of care and constitutes abuse. The facility failed to protect AV from physical abuse, 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.” 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.