S&C QCOR PRTF 2567s
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PRTF 2567s
Selection Criteria ▸

Time Interval

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Provider Characteristics

Use these filters if you want to limit the report to providers that have certain characteristics. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

Survey Type & Deficiency Tags

Use these filters if you want to limit the reports to providers on specific survey types, or to reports that were cited for specific PRTF deficiency tags and tag types. To select more than one option, hold down the Ctrl (individual point-and-click) OR Shift keys (select through a range) while you click on the additional desired option(s).

CCN and Facility Name

Use these filters if you know the name (or partial name) of the facility you are searching for, or the CMS Certification Number (CCN) for the facility you are searching for.

Other Survey Characteristics

Select one of the options below to filter by surveys that cite deficiencies or by surveys that are deficiency-free. By default, only surveys that cite deficiencies are displayed. Selecting "All" displays all surveys.

CMS Certification Number Facility Name Address City State CMS Region Date of CMS Survey Survey Event ID Survey Type Statement of Deficiencies Report
▼ 38L009 Children's Farm (Trillium) 4455 Ne Highway 20 Corvallis OR 10 (Seattle) 03/04/2021 9XHO11 Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0020 Policies for evac. and primary/alt. comm. Standard
E0025 Arrangement with other facilities Standard
N0178 Notification of parent(s) or legal guardian Standard
N0196 Medical treatment for injuries Standard
N0106 Beneficiary and accreditation requirement Element
N0114 Individual plan of care Element
N0115 Individual plan of care Element
N0136 Protection of residents Element
N0179 Notification of parent(s) or legal guardian Element
N0218 Education and training Element
▼ 38L010 Jasper Mountain 3787 Jasper Lowell Road Jasper OR 10 (Seattle) 10/08/2025 QXUX11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0037 Ep training program Standard
N0178 Notification of parent(s) or legal guardian Standard
N0188 Post intervention debriefings Standard
N0106 Beneficiary and accreditation requirement Element
N0115 Individual plan of care Element
N0149 Orders for use of restraint or seclusion Element
N0218 Education and training Element
N0221 Education and training Element
N0222 Education and training Element
▼ 38L010 Jasper Mountain 3787 Jasper Lowell Road Jasper OR 10 (Seattle) 10/29/2020 IV4J11 Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0009 Local, state, tribal collaboration process Standard
E0025 Arrangement with other facilities Standard
E0039 Ep testing requirements Standard
N0188 Post intervention debriefings Standard
N0196 Medical treatment for injuries Standard
N0106 Beneficiary and accreditation requirement Element
N0136 Protection of residents Element
N0137 Protection of residents Element
N0197 Medical treatment for injuries Element
N0222 Education and training Element
▼ 38L011 Kairos Northwest 711 Ramsey Ave Grants Pass OR 10 (Seattle) 05/06/2021 EXF311 Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0009 Local, state, tribal collaboration process Standard
E0023 Policies/procedures for medical documentation Standard
E0025 Arrangement with other facilities Standard
E0039 Ep testing requirements Standard
N0165 Monitoring during and after restraint Standard
N0196 Medical treatment for injuries Standard
N0106 Beneficiary and accreditation requirement Element
N0114 Individual plan of care Element
N0136 Protection of residents Element
N0137 Protection of residents Element
N0145 Orders for use of restraint or seclusion Element
N0179 Notification of parent(s) or legal guardian Element
N0197 Medical treatment for injuries Element
N0222 Education and training Element
▼ 38L013 Jasper Mountain's Safe Center 89124 Marcola Road Springfield OR 10 (Seattle) 10/09/2025 T8EL11 Recertification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0037 Ep training program Standard
N0188 Post intervention debriefings Standard
N0106 Beneficiary and accreditation requirement Element
N0189 Post intervention debriefings Element
N0218 Education and training Element
N0222 Education and training Element
▼ 38L013 Jasper Mountain's Safe Center 89124 Marcola Road Springfield OR 10 (Seattle) 10/29/2020 KZF711 Other-Fed
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0009 Local, state, tribal collaboration process Standard
E0025 Arrangement with other facilities Standard
E0039 Ep testing requirements Standard
N0188 Post intervention debriefings Standard
N0196 Medical treatment for injuries Standard
N0136 Protection of residents Element
N0137 Protection of residents Element
N0189 Post intervention debriefings Element
N0197 Medical treatment for injuries Element
N0222 Education and training Element
▼ 38L015 Looking Glass Community Services 550 River Road Eugene OR 10 (Seattle) 03/16/2023 N66W11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0037 Ep training program Standard
N0189 Post intervention debriefings Element
N0190 Post intervention debriefings Element
N0191 Post intervention debriefings Element
N0192 Post intervention debriefings Element
N0218 Education and training Element
▼ 38L016 Monte Nido Affiliates 1148 Rosemont Road West Linn OR 10 (Seattle) 07/19/2023 9X6D11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
N0000 Initial comments - not a deficiency citation Memo
N0106 Beneficiary and accreditation requirement Element
N0218 Education and training Element
▼ 38L017 Madrona Recovery 7000 S.W. Varns Street Tigard OR 10 (Seattle) 09/17/2024 1Q5F11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0037 Ep training program Standard
N0160 Consultation with treatment team physician Standard
N0188 Post intervention debriefings Standard
N0106 Beneficiary and accreditation requirement Element
N0115 Individual plan of care Element
N0135 Protection of residents Element
N0143 Orders for use of restraint or seclusion Element
N0145 Orders for use of restraint or seclusion Element
N0149 Orders for use of restraint or seclusion Element
N0167 Monitoring during and after restraint Element
N0189 Post intervention debriefings Element
N0216 Education and training Element
N0217 Education and training Element
N0218 Education and training Element
▼ 38L018 Nexus Family Healing- Walden Crossing 722 Ne 162nd Avenue Portland OR 10 (Seattle) 09/04/2024 98HB11 Initial Certification
Deficiency Tag Deficiency Description Tag Type
E0000 Initial comments - not a deficiency citation Memo
N0000 Initial comments - not a deficiency citation Memo
E0037 Ep training program Standard
N0107 Beneficiary and accreditation requirement Element