Nursing Care Index

Avamere Rehabilitation Of Oregon City

Oregon City, Clackamas County, Oregon · CCN 385125 · For-profit (LLC) · part of Avamere (27 facilities, chain average 3 stars)

CMS rates Avamere Rehabilitation Of Oregon City 2 of 5 overall as of August 2026. 111 certified beds, 62 residents a day on average. 61 citations on record from the current inspection cycles, 3 involving actual harm; 1 fine totalling $85,768.

CMS’s ratings

The Five-Star Quality Rating System, as CMS publishes it. Where CMS gives no rating, the reason CMS gives is printed instead.

Overall★★☆☆☆ 2 of 5
Health inspections★★☆☆☆ 2 of 5
Staffing★★★★☆ 4 of 5
Quality measures★★★☆☆ 3 of 5
Quality: long-stay / short-stay3 / 4 of 5

Staffing

Total nurse staffing5.26286 hours per resident per day
Registered nurses0.46564 hours per resident per day
Weekend total4.72147 hours per resident per day
Nursing staff turnover52.6% (registered nurses 70%)
Administrators who left0

Citations from health inspections

Each is a finding by a state surveyor on the date shown, in CMS’s words. The severity is CMS’s scope-and-severity grid, spelled out: harm on the left, how widespread on the right.

SurveyFindingSeverityStatus
2025-08-29
complaint survey
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies · tag F0689
G Actual harm that is not immediate jeopardy; isolated Past Non-Compliance
2025-06-26
2025-06-06 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.
Pharmacy Service Deficiencies · tag F0761
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2025-07-02
2025-06-06 Ensure that residents are fully informed and understand their health status, care and treatments.
Resident Rights Deficiencies · tag F0552
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-06-06 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.
Resident Rights Deficiencies · tag F0584
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-06-06
complaint survey
Respond appropriately to all alleged violations.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0610
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-06-06 Coordinate assessments with the pre-admission screening and resident review program; and referring for services as needed.
Resident Assessment and Care Planning Deficiencies · tag F0644
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-06-06 Assist a resident in gaining access to vision and hearing services.
Quality of Life and Care Deficiencies · tag F0685
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-06-06 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.
Quality of Life and Care Deficiencies · tag F0688
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-06-06 Provide and implement an infection prevention and control program.
Infection Control Deficiencies · tag F0880
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-07-02
2025-01-17
complaint survey
Prepare residents for a safe transfer or discharge from the nursing home.
Resident Rights Deficiencies · tag F0624
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-02-28
2025-01-17
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-02-28
2025-01-17
complaint survey
Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary Deficiencies · tag F0804
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2025-02-28
2024-02-13
complaint survey
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies · tag F0686
G Actual harm that is not immediate jeopardy; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Administration Deficiencies · tag F0867
F No actual harm, with potential for more than minimal harm; widespread Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Nursing and Physician Services Deficiencies · tag F0725
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Observe each nurse aide's job performance and give regular training.
Nursing and Physician Services Deficiencies · tag F0730
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Post nurse staffing information every day.
Nursing and Physician Services Deficiencies · tag F0732
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Nursing and Physician Services Deficiencies · tag F0947
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Allow residents to self-administer drugs if determined clinically appropriate.
Resident Rights Deficiencies · tag F0554
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
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.
Resident Rights Deficiencies · tag F0578
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
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.
Resident Rights Deficiencies · tag F0584
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Protect each resident from the wrongful use of the resident's belongings or money.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0602
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0609
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Respond appropriately to all alleged violations.
Freedom from Abuse, Neglect, and Exploitation Deficiencies · tag F0610
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13 Assess the resident completely in a timely manner when first admitted, and then periodically, at least every 12 months.
Resident Assessment and Care Planning Deficiencies · tag F0636
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Assess the resident when there is a significant change in condition
Resident Assessment and Care Planning Deficiencies · tag F0637
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Ensure each resident receives an accurate assessment.
Resident Assessment and Care Planning Deficiencies · tag F0641
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured.
Resident Assessment and Care Planning Deficiencies · tag F0656
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Resident Assessment and Care Planning Deficiencies · tag F0657
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Ensure services provided by the nursing facility meet professional standards of quality.
Resident Assessment and Care Planning Deficiencies · tag F0658
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies · tag F0677
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Assist a resident in gaining access to vision and hearing services.
Quality of Life and Care Deficiencies · tag F0685
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide appropriate foot care.
Quality of Life and Care Deficiencies · tag F0687
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
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.
Quality of Life and Care Deficiencies · tag F0688
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Quality of Life and Care Deficiencies · tag F0689
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies · tag F0695
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide safe, appropriate pain management for a resident who requires such services.
Quality of Life and Care Deficiencies · tag F0697
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide safe, appropriate dialysis care/services for a resident who requires such services.
Quality of Life and Care Deficiencies · tag F0698
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies · tag F0759
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide or obtain dental services for each resident.
Quality of Life and Care Deficiencies · tag F0791
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide special eating equipment and utensils for residents who need them and appropriate assistance.
Nutrition and Dietary Deficiencies · tag F0810
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2024-02-13
complaint survey
Provide or get specialized rehabilitative services as required for a resident.
Quality of Life and Care Deficiencies · tag F0825
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2024-04-02
2023-01-13 Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · tag F0684
G Actual harm that is not immediate jeopardy; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Nursing and Physician Services Deficiencies · tag F0725
F No actual harm, with potential for more than minimal harm; widespread Deficient, Provider has date of correction
2023-02-22
2023-01-13 Provide sufficient support personnel to safely and effectively carry out the functions of the food and nutrition service.
Nutrition and Dietary Deficiencies · tag F0802
F No actual harm, with potential for more than minimal harm; widespread Deficient, Provider has date of correction
2023-02-22
2023-01-13 Ensure food and drink is palatable, attractive, and at a safe and appetizing temperature.
Nutrition and Dietary Deficiencies · tag F0804
F No actual harm, with potential for more than minimal harm; widespread Deficient, Provider has date of correction
2023-02-22
2023-01-13 Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies · tag F0812
F No actual harm, with potential for more than minimal harm; widespread Deficient, Provider has date of correction
2023-02-22
2023-01-13 Set up an ongoing quality assessment and assurance group to review quality deficiencies and develop corrective plans of action.
Administration Deficiencies · tag F0867
F No actual harm, with potential for more than minimal harm; widespread Deficient, Provider has date of correction
2023-02-22
2023-01-13 Honor the resident's right to organize and participate in resident/family groups in the facility.
Resident Rights Deficiencies · tag F0565
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2023-02-22
2023-01-13 Provide activities to meet all resident's needs.
Quality of Life and Care Deficiencies · tag F0679
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2023-02-22
2023-01-13 Ensure the activities program is directed by a qualified professional.
Quality of Life and Care Deficiencies · tag F0680
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2023-02-22
2023-01-13 Post nurse staffing information every day.
Nursing and Physician Services Deficiencies · tag F0732
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2023-02-22
2023-01-13 Have a policy regarding use and storage of foods brought to residents by family and other visitors.
Nutrition and Dietary Deficiencies · tag F0813
E No actual harm, with potential for more than minimal harm; pattern Deficient, Provider has date of correction
2023-02-22
2023-01-13 Reasonably accommodate the needs and preferences of each resident.
Resident Rights Deficiencies · tag F0558
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Honor the resident's right to and the facility must promote and facilitate resident self-determination through support of resident choice.
Resident Rights Deficiencies · tag F0561
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals.
Resident Assessment and Care Planning Deficiencies · tag F0657
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Provide the appropriate treatment and services to a resident who displays or is diagnosed with dementia.
Quality of Life and Care Deficiencies · tag F0744
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Ensure each resident’s drug regimen must be free from unnecessary drugs.
Pharmacy Service Deficiencies · tag F0757
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Ensure medication error rates are not 5 percent or greater.
Pharmacy Service Deficiencies · tag F0759
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22
2023-01-13 Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Nutrition and Dietary Deficiencies · tag F0806
D No actual harm, with potential for more than minimal harm; isolated Deficient, Provider has date of correction
2023-02-22

Fines and payment denials

DatePenaltyAmount
2024-02-13Fine$85,768

Who owns and runs it

Every owner, officer and manager CMS lists, as filed. These are the names in CMS’s ownership record; anyone named in the ownership record can ask about it on the about page.

NameRoleShareSince
Midcap Finco LLC
Organization
5% or greater security interest2013-06-25
Avamere Health Services LLC
Organization
adp of the snf2025-07-10
Avamere Skilled Advisors LLC
Organization
adp of the snf2025-07-14
Moss Adams LLP
Organization
adp of the snf2009-01-01
Ariso LLC
Organization
direct ownership interest2006-01-06
Ari Operations, LLC
Organization
indirect ownership interest2006-01-06
Avamere Group LLC
Organization
indirect ownership interest2006-01-06
Karl Rickard Miller Jr Revocable Trust
Organization
indirect ownership interest2011-07-11
Avamere Health Services LLC
Organization
operational/managerial control2005-01-01
Avamere Skilled Advisors LLC
Organization
operational/managerial control2005-01-01
Midcap Finco LLC
Organization
operational/managerial control2013-06-25
Angerhofer, Nicole
Individual
adp of the snf2023-12-01
Dana, Jennifer
Individual
adp of the snf2022-05-01
Davis, Julie
Individual
adp of the snf2024-08-01
Doepker, Andrea
Individual
adp of the snf2023-09-08
Feakin, Cody
Individual
adp of the snf2025-01-01
Funderberg, Michelle
Individual
adp of the snf2024-12-31
Games, Kim
Individual
adp of the snf2024-08-15
Hill, Kevin
Individual
adp of the snf2022-03-12
Inskeep, Todd
Individual
adp of the snf2022-01-21
James, Allen
Individual
adp of the snf2025-07-10
Kofstad, Mary
Individual
adp of the snf2024-02-13
Lee, Carie
Individual
adp of the snf2024-05-01
Munro, Jolynn
Individual
adp of the snf2023-09-01
Polson, Justin
Individual
adp of the snf2025-02-10
Powelson, Michele
Individual
adp of the snf2015-03-25
Presley, Yolanda
Individual
adp of the snf2025-01-06
Reid, Misty
Individual
adp of the snf2025-01-02
Simpson, Andrew
Individual
adp of the snf2024-06-01
Staples, Carolyn
Individual
adp of the snf2023-10-05
Strunk, Colby
Individual
adp of the snf2022-09-06
Vanderzanden, Carrie
Individual
adp of the snf2025-01-01
Vellody, Nita
Individual
adp of the snf2020-08-01
Yount, Mark
Individual
adp of the snf2019-10-01
Miller, Karl
Individual
indirect ownership interest2001-07-20
Kofstad, Mary
Individual
individual is an owner, partner or trustee of any adp of the snf2026-03-11
Cavallo, Glen
Individual
managing control - governing body2025-06-01
Feakin, Cody
Individual
managing control - governing body2025-06-01
Funderberg, Michelle
Individual
managing control - governing body2025-06-01
Haskins, Damien
Individual
managing control - governing body2025-09-01
Hill, Kevin
Individual
managing control - governing body2025-06-01
Hoskins, Tonia
Individual
managing control - governing body2025-06-01
Inskeep, Todd
Individual
managing control - governing body2025-06-01
Kofstad, Mary
Individual
managing control - governing body2025-06-01
Munro, Jolynn
Individual
managing control - governing body2025-06-01
Okoli, Ike
Individual
managing control - governing body2025-06-01
Polson, Justin
Individual
managing control - governing body2025-06-01
Powelson, Michele
Individual
managing control - governing body2025-06-01
Reid, Misty
Individual
managing control - governing body2025-06-01
Sanders, Amanda
Individual
managing control - governing body2025-06-01
Simpson, Andrew
Individual
managing control - governing body2025-06-01
Strunk, Colby
Individual
managing control - governing body2025-06-01
Vanderzanden, Carrie
Individual
managing control - governing body2025-06-01
Angerhofer, Nicole
Individual
operational/managerial control2023-12-01
Dana, Jennifer
Individual
operational/managerial control2022-05-01
Doepker, Andrea
Individual
operational/managerial control2023-09-28
Feakin, Cody
Individual
operational/managerial control2025-07-15
Hoskins, Tonia
Individual
operational/managerial control2024-07-19
James, Allen
Individual
operational/managerial control2022-07-08
Kofstad, Mary
Individual
operational/managerial control2024-02-13
Lee, Carie
Individual
operational/managerial control2024-05-01
Munro, Jolynn
Individual
operational/managerial control2023-09-01
Powelson, Michele
Individual
operational/managerial control2015-03-25
Presley, Yolanda
Individual
operational/managerial control2025-01-06
Reid, Misty
Individual
operational/managerial control2025-01-02
Simpson, Andrew
Individual
operational/managerial control2024-06-01
Vellody, Nita
Individual
operational/managerial control2020-08-01

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Source: Centers for Medicare & Medicaid Services, Provider Data Catalog (public domain), files dated 2026-08-01. Ratings are CMS’s; citations are state surveyors’ findings; nothing here is estimated or a recommendation. Every nursing home in Clackamas County.