Based on interview the facility failed to ensure staff were employable for 1 of 6 staff (#10) reviewed for personnel files. This placed residents at risk for abuse. Findings include: On 7/25/23 at 3:08 PM Staff 10's (former CNA) personnel file was requested from Staff 1 (Administrator) as a result of a staff to resident verbal abuse allegation. On 7/26/23 at 1:40 PM Staff 17 (Regional Director of Operations) stated Staff 10's personnel file was in a storage unit offsite. Staff 1 confirmed the file was in an offsite storage unit. On 7/31/23 at 12:26 PM Staff 1 stated he could not find Staff 10's file. No documentation was provided to confirm Staff 10 was employable by the state licensure agency.
F606 citations in Oregon
Freedom from Abuse, Neglect, and Exploitation Deficiencies
Not hire anyone with a finding of abuse, neglect, exploitation, or theft.
Data as of , released by CMS on October 8, 2026. Source: CMS Provider Data Catalog.
Against expectation — 2023
Oregon cites F606 more often than its own record predicts
1.58 times the share F606 takes of citations nationally.
Of every deficiency written in Oregon in 2023, this is the portion that was F606.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Oregon surveyors wrote
F606 findings written in Oregon, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
What else Oregon surveyors cite →
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