Not rated by CMS — ratings are suppressed for new or low-volume facilities.
The next survey window likely opens around December 2026
Estimate from public CMS data, current as of June 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Clatsop Care Center during CMS and state inspections, most recent first.
The facility failed to maintain a homelike environment due to dirty windows, as observed and reported by a resident. The Maintenance Director confirmed that the outside windows had only been cleaned twice in the last eight years, acknowledging the need for cleaning.
The facility failed to comprehensively assess three residents for medications, behavior, and mood, leading to incomplete assessments and unmet care needs. One resident's psychotropic CAA lacked specific behavior descriptions and risk factors, while another's CAA did not specify how dementia and depression impacted them. A third resident's CAA omitted potential problems and non-pharmacological interventions. Staff acknowledged the lack of detailed information in these assessments.
A resident with hypothyroidism and constipation did not receive prescribed levothyroxine for several days, and bowel care medications were not administered as ordered during episodes of constipation. The facility failed to follow physician orders, as confirmed by the DNS.
A facility failed to label medications with proper administration instructions, leading to a CMA crushing pantoprazole 40 mg DR before giving it to a resident. The medication, which should not be crushed, was not labeled with the necessary instructions, posing a risk for decreased efficacy. A Consultant Pharmacist confirmed the labeling oversight.
A resident with dementia and depression had a physician's order for mirtazapine incorrectly transcribed, resulting in a lack of evidence that the medication was administered for several days. The facility's administrator and RNCM confirmed the errors and noted the physician clarified the order with a new start date.
A resident with atrial fibrillation was improperly administered Coumadin due to a duplicate order inputted by an LPN, resulting in the resident receiving extra doses over six days. This error led to the resident being hospitalized and requiring a Vitamin K infusion to counteract the effects of the excess anticoagulant.
Failure to Maintain Clean Windows in Facility
Penalty
Summary
The facility failed to maintain a homelike environment due to the lack of cleanliness of the windows. This deficiency was identified through both observation and interview. On September 9, 2024, a resident expressed dissatisfaction with the cleanliness of their windows, stating they were very dirty and requested they be cleaned. Observations confirmed that the majority of windows throughout the facility were dirty and did not contribute to a homelike environment. On September 13, 2024, the Maintenance Director acknowledged that the outside windows had only been cleaned twice in the last eight years and confirmed the need for cleaning.
Incomplete Resident Assessments for Medications and Behavior
Penalty
Summary
The facility failed to comprehensively assess three residents for medications, behavior, and mood, leading to incomplete assessments and unmet care needs. Resident 83, admitted with a recent stroke and delirium, was prescribed antipsychotic medication. However, the psychotropic Care Area Assessment (CAA) did not describe the specific behavior necessitating the medication, nor did it include causes, contributing factors, or risk factors such as increased drowsiness or fall risk. This lack of analysis was confirmed by the Director of Nursing Services (DNS). Resident 8, diagnosed with dementia and depression, had CAAs that failed to specify how these conditions were problematic or impacted the resident, nor did they provide a rationale for care planning decisions. The Social Service Director acknowledged insufficient information in the CAAs. Similarly, Resident 25, with schizophrenia and lung cancer, had a CAA that did not include potential problems, manifested behaviors, or non-pharmacological interventions. The LPN responsible for training staff on completing CAAs confirmed the lack of detailed information in the assessments.
Failure to Administer Medications and Bowel Care
Penalty
Summary
The facility failed to adhere to physician orders for medication administration and bowel care for a resident diagnosed with hypothyroidism and constipation. The resident was prescribed levothyroxine to be administered daily at a specific time, but the medication was not given from September 6 to September 11, 2024. This lapse was confirmed by the Director of Nursing Services (DNS) without any explanation provided for the missed doses. Additionally, the facility did not follow the prescribed bowel care regimen for the resident. Despite having orders for bisacodyl, fleet enema, and milk of magnesia to be administered after specific periods of no bowel movement, these medications were not given as required. The resident experienced multiple episodes of constipation where the medications were not administered on the designated days, as confirmed by the DNS upon review of the bowel care records for August and September 2024.
Medication Labeling Deficiency
Penalty
Summary
The facility failed to ensure medications were labeled with administration instructions, specifically for one resident during medication administration observation. On September 11, 2024, a Certified Medication Aide (CMA) was observed crushing pantoprazole 40 mg DR (delayed release) before administering it to a resident. The manufacturer's instructions indicate that this medication is enteric-coated to pass through the stomach and should not be crushed. However, the medication was labeled only as pantoprazole 40 mg, without the DR designation, and there were no instructions on the Medication Administration Record (MAR) or the medication bubble pack from the pharmacy indicating that the medication should not be crushed. On September 12, 2024, a Consultant Pharmacist confirmed that pantoprazole 40 mg should not be crushed and noted that the medication was not labeled with instructions not to crush. This oversight placed residents at risk for decreased medication efficacy.
Incomplete and Inaccurate Medical Records for Medication Administration
Penalty
Summary
The facility failed to ensure complete and accurate medical records for a resident admitted with dementia and depression. The resident had a physician's order for mirtazapine, an appetite stimulant, which was incorrectly transcribed. The initial order was for a short-term administration, but a subsequent order extended the medication for 30 days. However, there was no evidence in the clinical record that the resident received the medication from August 16 to August 25. During an interview, the facility's administrator and RNCM acknowledged the transcription errors and stated that the physician clarified the order with a new start date.
Medication Error Leads to Hospitalization
Penalty
Summary
The facility failed to properly administer anticoagulant medication to a resident diagnosed with paroxysmal atrial fibrillation, who was receiving Coumadin as part of their treatment plan. The resident's physician orders specified that Coumadin 5 mg should be administered every Tuesday, Friday, and Sunday at 4:00 PM. However, a review of the resident's medication administration record (MAR) for November 2023 revealed that the resident received an additional dose of Coumadin at 8:00 AM on the same days, resulting in two doses being administered on each of those days. The error was traced back to a duplicate order inputted by an LPN, which led to the resident receiving extra doses of Coumadin for six days. This medication error resulted in the resident being hospitalized after lab tests showed critical results, necessitating a Vitamin K infusion to reverse the effects of the excess anticoagulant. The facility's investigation confirmed the duplicate order and the subsequent hospitalization of the resident due to the medication error.
Removal Plan
- The effected resident was assessed and sent to the emergency department for Vitamin K infusion.
- An audit of all anticoagulant orders were reviewed for accuracy.
- All nursing staff were provided education related to administration of Coumadin including warning systems to prevent duplicate orders.
- Education was received by consultant pharmacist on avoiding medication errors.
- Anticoagulation orders for residents continued to be monitored and triple checked for accuracy.
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Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
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Nursing homes near Astoria
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Willapa Harbor Care | 34 mi | — | 0 | 0 |
| Nehalem Valley Care Center | 34.7 mi | — | 1 | 0 |
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Trusted data, never guesswork. Every citation, penalty, rating and Plan of Correction on this page is sourced from public CMS records (latest release August 2026) and official state health department websites.