Compiled from official CMS federal data
VILLAGE HEALTH CARE, GRESHAM, OR — Violations & Inspection Reports
Does VILLAGE HEALTH CARE have a federal violation or abuse history?
According to the public federal record on file with the Centers for Medicare & Medicaid Services (CMS), VILLAGE HEALTH CARE (CCN 385068), in GRESHAM, OR, has federal inspection findings.
In its current inspection cycle, CMS cited the facility for 28 deficiencies; the most severe is rated F — which CMS classifies as "potential for harm," a level below actual harm (risk, but no harm confirmed). The latest standard health inspection on file is dated 2025-02-03. Earlier-cycle citations appear in the dated timeline below as historical, not current. CMS has $4,225 in civil money penalties on file against the facility. The record also includes 1 abuse- or neglect-related citation in CMS's "Freedom from Abuse, Neglect, and Exploitation" family (F600-series; most recent Nov 2019). This page restates the federal record and draws no conclusion of its own.
Abuse-, fall-, and care-related findings on the federal record
- 1 citation in CMS's "Freedom from Abuse, Neglect, and Exploitation" family (F600-series) — most recent Nov 2019.
- 1 citation for accident hazards or inadequate supervision (F689) — the deficiency family behind fall-related findings; most recent Feb 2026.
- 1 pressure-ulcer care citation (F686) — the consumer term is "bedsores"; most recent Nov 2025.
- 12 findings on file from complaint-triggered inspections.
Every figure above restates CMS’s own dated record; this page draws no conclusion of its own. Strict state filing deadlines can apply to nursing-home injury claims — a licensed attorney in your state can review this record.
FOR FAMILIES
What brings you to this record?
The Federal Record
Federal abuse- or neglect-related citations on record (F600-series).
Below is this facility's federal inspection record as on file with CMS.
Scope & Severity — current cycle
CMS's own A–L scope/severity grid. Plotted cells mark this facility's most recent (current-cycle) citations.
Civil money penalties on file
$4,225
Have a lawyer review this record →
About this record: Federal nursing-home surveys are conducted on a recurring cycle by state survey agencies acting on CMS's behalf, and the figures on this page are compiled from CMS's published provider data, as on file with CMS; the federal record may understate what actually occurred, and inspection findings are point-in-time survey results, not a determination that any specific resident was harmed.
Deficiency timeline
Citations are listed by scope/severity (most severe first), not chronologically; each entry is labeled current-cycle or historical.
Ensure that residents are free from significant medication errors.
Provide and implement an infection prevention and control program.
Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.
37 more citations on file — Abuse & neglect 1 · Accidents & supervision 1 · Pressure ulcers 1 · Medication & pharmacy 5 · Resident rights 10 · Other citations 19 (expand)
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Ensure residents have reasonable access to and privacy in their use of communication methods.
Give residents a notice of rights, rules, services and charges.
Provide activities to meet all resident's needs.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Assist a resident in gaining access to vision and hearing services.
Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Ensure that residents are fully informed and understand their health status, care and treatments.
Allow resident to participate in the development and implementation of his or her person-centered plan of care.
Allow residents to self-administer drugs if determined clinically appropriate.
Reasonably accommodate the needs and preferences of each resident.
Give residents notice of Medicaid/Medicare coverage and potential liability for services not covered.
Ensure each resident receives an accurate assessment.
Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Provide appropriate care for a resident to maintain and/or improve range of motion (ROM), limited ROM and/or mobility, unless a decline is for a medical reason.
Provide safe, appropriate pain management for a resident who requires such services.
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Implement gradual dose reductions(GDR) and non-pharmacological interventions, unless contraindicated, prior to initiating or instead of continuing psychotropic medication; and PRN orders for psychotropic medications are only used when the medication is necessary and PRN use is limited.
Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Post nurse staffing information every day.
Honor the resident's right to request, refuse, and/or discontinue treatment, to participate in or refuse to participate in experimental research, and to formulate an advance directive.
Post nurse staffing information every day.
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Honor the resident's right to a safe, clean, comfortable and homelike environment, including but not limited to receiving treatment and supports for daily living safely.
Ensure drugs and biologicals used in the facility are labeled in accordance with currently accepted professional principles; and all drugs and biologicals must be stored in locked compartments, separately locked, compartments for controlled drugs.
Ensure each resident’s drug regimen must be free from unnecessary drugs.
Ensure medication error rates are not 5 percent or greater.
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Provide safe and appropriate respiratory care for a resident when needed.
Ensure each resident receives an accurate assessment.
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Overall CMS star rating
This facility: 1 · CMS state average: 3.1
Both figures as published by CMS.
You may be reading this record for the first time.
If something happened to someone you love at this facility, this federal record may be new to you today. The company that operates a nursing home, by contrast, is rarely seeing records like this for the first time — operators like these typically retain standing legal, risk, and insurance teams whose routine work includes records exactly like the one on this page. That is not a judgment of this facility; it is how the business is structured. Because strict time limits can apply, families often find it helps to have a qualified person review the record with them sooner rather than later.
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Federal record
VILLAGE HEALTH CARE — Federal Record
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SECTION 7 — CASE CONTEXT
Add what you saw at VILLAGE HEALTH CARE to this record
No call centers, no auctions. CareSentinel is an independent service that compiles the public CMS record and does not provide legal advice. The federal record is a point-in-time inspection record and may understate what actually occurred. CareSentinel is operated by Nodal Logics LLC.
Strict time limits can apply to taking legal action — consider consulting a qualified attorney promptly.
If you believe a resident is in immediate danger, call 911. Care concerns can also be reported at no cost to your state survey agency or the Long-Term Care Ombudsman program (ltcombudsman.org) — independent of any legal inquiry.
How to read this record
Making sense of a CMS inspection record
CMS scores every citation on a grid from A to L, combining how widespread a finding was with how serious it was. A–C is a deficiency CMS classifies as no harm; D–F as the potential for harm; G–I as actual harm that reached a resident; and J–L as immediate jeopardy, CMS’s most serious level. Later letters mark more serious findings.
Three questions to ask on a tour
- How is the home staffed on nights, weekends, and holidays?
- What happens when a resident’s condition changes suddenly?
- How, and how quickly, are families told about an incident?