Cedar Crossings
6003 Se 136th Avenue, Portland, OR 97236 · Multnomah County · (971) 978-1268
89 certified beds, about 79 residents a day · For profit - Limited Liability company · Medicare and Medicaid since 2021
Certified for Medicaid Certified for Medicare
Overall
3 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
5 of 5
CMS Care Compare ratings, data as of September 1, 2026 · CCN 385284 · See it on Medicare.gov · Compare with other homes
The record in brief
At its most recent standard inspection, on May 22, 2026, inspectors cited 8 health deficiencies (the Oregon average is 9.2, the national average 9.2).
Of 57 health citations since August 2023, 2 were rated as actual harm or immediate jeopardy to residents (1 immediate jeopardy).
CMS lists 2 fines totaling $32,383 in the last three years; the largest was $24,193, and the latest is dated June 17, 2024.
Nurses and nurse aides worked 5.24 hours per resident per day, against 5.03 across Oregon and 3.86 nationally. Registered nurses accounted for 0.42 of those hours.
64.5% of nursing staff left within the year CMS measured (Oregon average 47.4%).
CMS links it to Sapphire Health Services, an affiliated group of 8 nursing homes.
Health inspections
Federal rules call for a standard inspection at least every 15 months, plus a visit whenever a complaint is filed. Each mark below is one citation, colored by how serious inspectors rated it. How to read a citation.
Under each citation, the quoted text is the inspector's own summary from the federal statement of deficiencies (CMS form 2567), word for word apart from a privacy scrub; CMS removes residents' and staff names before it publishes the text. The full notes are on Medicare.gov.
2008/23
311/23
203/24
306/24
207/24
310/24
1501/25
104/26
805/26
Potential for minimal harm Potential for more than minimal harm Actual harm Immediate jeopardy Found on a complaint visit
Where its citations fall on CMS's grid
CMS rates every citation by how much harm it caused (rows) and how many residents it touched (columns). The count in each box is this home's, across all 57 health citations on file.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
1J
0K
0L
Actual harm
1G
0H
0I
Potential for more than minimal harm
41D
10E
2F
Potential for minimal harm
0A
2B
0C
May 22, 2026Standard inspection · 8 citations
- E 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.
Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to ensure proper labeling of biologicals for 1 of 2 medication rooms, and failed to ensure medication and medication carts were properly secured for 4 of 4 random observations of medication carts reviewed for medication storage. This placed residents at risk for reduced efficacy of medication and unauthorized access to medications.
- D 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.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to maintain a homelike environment for 1 of 3 sampled residents (#44) reviewed for environment. This placed residents at risk for an unsafe and unkempt physical environment.
- D Prevent the use of unnecessary psychotropic medications or use medications that may restrain a resident's ability to function.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure gradual dose reductions were completed when indicated for 1 of 5 sampled residents (#1) reviewed for medications. This placed residents at risk for adverse side effects of psychotropic medication.
- D Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Inspectors wroteBased on interview and record review it was determined the facility failed to complete a baseline care plan within 48 hours of a resident's admission for 1 of 5 sampled residents (#40) reviewed for medications. This placed residents at risk for unmet basic care needs.
- D Assist a resident in gaining access to vision and hearing services.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure residents received an assistive device to maintain vision ability for 1 of 1 resident (#48) reviewed for vision. This placed residents at risk for increased visual deficits.
- D Provide pharmaceutical services to meet the needs of each resident and employ or obtain the services of a licensed pharmacist.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure resident narcotic drug records were in order and an account of all controlled drugs was maintained for 1 of 4 medication carts reviewed for medication storage. This placed residents at risk for inaccurate clinical records related to narcotics and drug diversion.
- D Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure pharmacist recommendations were addressed for 2 of 5 sampled residents (#s 1 and 10) reviewed for unnecessary medications. This placed residents at risk for receiving ineffective or unnecessary medications.
- D Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure resident medical records were kept secured and confidential for 2 of 2 random observations. This placed residents at risk for lack of privacy and confidentiality.
April 3, 2026Complaint inspection · 1 citation
- D Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to ensure staff were aware of residents who were an elopement risk and aware of elopement care plan interventions for 1 of 3 sampled residents (#1) reviewed for elopement. This placed residents at risk for elopement.
January 17, 2025Standard inspection, Complaint inspection · 15 citations
- E 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.
Inspectors wroteBased on observation and interview it was determined the facility failed to maintain a safe, clean and homelike environment on 1 of 1 facility and 1 of 2 resident dining rooms reviewed for environment. This placed residents at risk for tripping and living in an unkept and unhomelike environment.
- E Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure staff completed timely smoking assessments and smoking materials were stored safely for 3 of 3 sampled residents (#s 22, 50, and 60) reviewed for accidents. This placed residents at risk for accidents and smoking hazards.
- E Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift.
Inspectors wroteBased on interview and record review the facility failed to provide sufficient nursing staff to ensure residents attained or maintained their highest practicable mental, physical, and psychosocial well-being for 5 of 9 sampled residents (#s 2, 8, 22, 26 and 57) reviewed for call light wait times and staffing. This placed residents at risk for lack of ADL care needs.
- E Observe each nurse aide's job performance and give regular training.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure each CNA received annual performance reviews for 5 of 5 randomly selected CNAs (#s 14, 15, 16, 17, and 18) reviewed for staffing. This failure placed residents at risk for lack of care by competent staff.
- E 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.
Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to ensure drugs and biologicals were secured and not expired for 3 of 4 medication carts reviewed for medication storage. This placed residents at risk for adverse medication effects.
- D Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on observation, interview, and record review it was determined the facility failed to provide care and treatment for 1 of 2 sampled residents (#56) reviewed for edema. This placed residents at risk for unmet needs.
- D Provide safe and appropriate respiratory care for a resident when needed.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure resident respiratory services were in place and equipment was maintained for 1 of 2 sampled residents (#54) reviewed for respiratory care. This placed residents at risk for breathing complications.
- D Provide safe, appropriate dialysis care/services for a resident who requires such services.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to administer medications and ensure communication forms were completed accurately for 1 of 1 sampled resident (#50) reviewed for dialysis (a procedure which removes waste products and excess fluid from the blood when the kidneys are no longer functioning properly). This placed residents at risk for lack of care and services, and potential medication side effects.
- D Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure pharmacist recommendations were addressed for 1 of 5 sampled residents (#66) reviewed for unnecessary medications. This placed residents at risk for receiving ineffective or unnecessary medications.
- D Provide or obtain dental services for each resident.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to provide dental services for 1 of 1 sampled resident (#36) reviewed for dental care needs. This placed residents at risk for unmet dental needs.
- D Dispose of garbage and refuse properly.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure waste was properly contained in dumpsters and the garbage storage area was maintained in a sanitary condition for 1 of 1 garbage area reviewed for kitchen sanitation. This placed residents at risk for potential exposure to pathogens related to the harborage and feeding of pests.
- D Provide and implement an infection prevention and control program.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to follow infection control practices for 2 of 4 sampled residents (#s 36 and 49) reviewed for infection control. This placed residents at risk for cross contamination.
- D Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention.
Inspectors wroteBased on interview and record review it was determined the facility failed to have a system in place to ensure CNA staff received 12 hours of in-service training annually for 5 of 5 randomly selected staff members (#s 14, 15, 16, 17, and 18) reviewed for in-service training. This placed residents at risk for lack of competent staff.
- B Provide timely notification to the resident, and if applicable to the resident representative and ombudsman, before transfer or discharge, including appeal rights.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure transfer notices with appeal rights were provided in writing to residents and their representatives for 2 of 2 sampled residents (#s 80 and 81) reviewed for hospitalizations. This placed residents at risk for lack of information regarding their options and rights.
- B Notify the resident or the resident’s representative in writing how long the nursing home will hold the resident’s bed in cases of transfer to a hospital or therapeutic leave.
Inspectors wroteBased on interview and record review it was determined the facility failed to provide residents with a written bed hold notification, including reserved bed hold payment, at the time of transfer to the hospital for 2 of 2 sampled residents (#s 80 and 81) reviewed for hospitalization. This placed residents at risk for lack of knowledge regarding their choices and potential financial responsibilities.
October 3, 2024Complaint inspection · 3 citations
- D Reasonably accommodate the needs and preferences of each resident.
Inspectors wroteBased on interview and record review it was determined the facility failed to provide bed rails needed for bed mobility for 1 of 3 sampled resident (#11) reviewed for environment. This placed residents at risk of ADL decline.
- D Permit a resident to return to the nursing home after hospitalization or therapeutic leave that exceeds bed-hold policy.
Inspectors wroteBased on interview and record review it was determined the facility failed to permit a resident to return to the facility for 1 of 4 sampled residents (#9) reviewed for discharge. This placed residents at risk for being unhoused.
- D Plan the resident's discharge to meet the resident's goals and needs.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure meals were provided for a discharge for 1 of 3 sampled residents (#5) reviewed for discharge. This placed residents at risk for unsafe discharge.
July 17, 2024Complaint inspection · 2 citations
- D Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure optometry services were provided timely for 1 of 3 sampled residents (#5) reviewed for quality of care. This placed residents at risk for unmet optical needs.
- D Provide or obtain dental services for each resident.
Inspectors wroteBased on observation, interview and record review review it was determined the facility failed to ensure routine dental services were provided for 1 of 3 sampled residents (#5) reviewed for dental care needs. This placed residents at risk for unmet dental needs.
June 17, 2024Complaint inspection · 3 citations
- J Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on interview and record review it was determined the facility failed to re-evaluate elopement risks and modify care plan interventions after ongoing elopement attempts and exit seeking behaviors for a resident with cognitive impairment and inability to effectively communicate her/his needs due to aphasia and CVA. This failure, determined to be an immediate jeopardy situation, resulted in Resident 1's elopement from the facility on 6/12/24 and placed residents at risk for an unsafe elopement.
- F Have a plan that describes the process for conducting QAPI and QAA activities.
Inspectors wroteBased on interview and record review, it was determined the facility failed to develop and present a QAPI plan to the State Survey Agency (SSA) and failed to present documentation and evidence of an ongoing QAPI Program. This placed residents at risk of not receiving the care and services for optimal resident outcomes.
- F Have the Quality Assessment and Assurance group have the required members and meet at least quarterly
Inspectors wroteBased on interview and record review it was determined the facility failed to have a quarterly QAA (Quality Assessment and Assurance) committee meeting and failed to include the Medical Director reviewed for quality assurance. This placed residents at risk of not receiving the care and services for optimal resident outcomes.
March 22, 2024Complaint inspection · 2 citations
- D Honor the resident's right to be treated with respect and dignity and to retain and use personal possessions.
Inspectors wroteBased on interview and record review, it was determined the facility failed to ensure a resident was spoken to in a dignified manner for 1 of 3 sampled residents (#2) reviewed for dignity. This placed residents at risk for decreased self-worth.
- D Provide care and assistance to perform activities of daily living for any resident who is unable.
Inspectors wroteBased on observation, interview, and record review, it was determined the facility failed to provide care and services to maintain mobility with transfers for 1 of 4 sampled residents (#3) reviewed for ADL care. This placed residents at risk for unmet ADL needs.
November 9, 2023Complaint inspection · 3 citations
- G Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on interview and record review it was determined the facility failed to provide appropriate supervision and implement fall interventions to prevent a resident fall with injury for 1 of 5 sampled residents (#1) reviewed for accidents. This failure resulted in Resident 1 requiring hospitalization and placed all residents at risk for falls.
- D Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure medical records for each resident were complete for 1 of 5 sampled resident (#1) reviewed for accidents. This placed residents at risk for incomplete medical records.
- D Make sure that a working call system is available in each resident's bathroom and bathing area.
Inspectors wroteBased on interview and record review it was determined the facility failed to ensure call lights were in good working order for 1 of 3 sampled residents (#3) reviewed for call lights. This placed residents at risk for unmet needs.
August 14, 2023Standard inspection · 20 citations
- E 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.
Inspectors wroteBased on observation and interview it was determined the facility failed to ensure a homelike environment was maintained in 2 of 4 halls and 1 of 3 dining rooms reviewed for environment. This placed residents at risk for lack of a homelike environment.
- E 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.
Inspectors wroteBased on observation and interview it was determined the facility failed to ensure medications and biologicals were secured and only accessible to authorized persons for 3 of 4 medication/treatment carts observed. This placed residents at risk for drug diversion.
- E Provide and implement an infection prevention and control program.
Inspectors wrote1. Based on observation and interview it was determined the facility failed to ensure staff performed appropriate and adequate hand hygiene and the provision of appropriate hand hygiene for residents during meal delivery for 1 of 4 halls observed during the lunch time meal. This placed residents at risk for infection and lack of hygiene.
- E Make sure that a working call system is available in each resident's bathroom and bathing area.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure residents' call lights were functional for 1 of 1 sampled facility reviewed for call lights. This placed residents at risk for unmet care needs.
- D Honor the resident's right to a dignified existence, self-determination, communication, and to exercise his or her rights.
Inspectors wrote1. Based on observation, interview and record review it was determined the facility failed to ensure a resident was treated with dignity and respect for 2 of 3 sampled residents (#s 9 and 41) reviewed for abuse. This placed residents at risk for impaired dignity.
- D Ensure that residents are fully informed and understand their health status, care and treatments.
Inspectors wroteBased on interview and record review it was determined the facility failed to obtain informed consent prior to administration of psychotropic medications for 2 of 5 sampled residents (#s 15 and 26) reviewed for unnecessary medications. This placed residents at risk for being uninformed of the risks and benefits of their medications.
- D Reasonably accommodate the needs and preferences of each resident.
Inspectors wrote1. Based on observation, interview and record review it was determined the facility failed to ensure the call light was in reach of the resident for 1 of 2 sampled residents (#65) reviewed for ADLs. This placed residents at risk for unmet needs.
- D Timely report suspected abuse, neglect, or theft and report the results of the investigation to proper authorities.
Inspectors wroteBased on interview and record review it was determined the facility failed to report an allegation of abuse to the state agency within the required timeframe for 2 of 5 sampled residents (#s 41 and 227) reviewed for abuse. This placed residents at risk for abuse.
- D Ensure each resident receives an accurate assessment.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to accurately code the resident MDS assessments for 2 of 8 sampled residents (#s 15 and 59) reviewed for dental, communication and sensory care. This placed residents at risk for inaccurate assessments and unmet care needs.
- D Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted
Inspectors wroteBased on interview and record review it was determined the facility failed to develop and provide a baseline care plan within 48 hours of admission for 1 of 5 sampled residents (#26) reviewed for medications. This placed residents at risk for being uninformed about their plan of care.
- D Provide care and assistance to perform activities of daily living for any resident who is unable.
Inspectors wroteBased on observation, interview and record review It was determined the facility failed to provide adequate bathing for 1 of 2 sampled residents (#227) reviewed for ADLs. This placed residents at risk for unmet bathing and personal hygiene needs.
- D Provide activities to meet all resident's needs.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to provide an ongoing person-centered activities program for 3 of 4 sampled residents (#s 27, 41 and 65) reviewed for activities. This placed residents at risk for a decline in psychosocial well-being and diminished quality of life.
- D Assist a resident in gaining access to vision and hearing services.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure treatment and services to maintain vision and hearing abilities were received for 2 of 4 sampled residents (#s 9 and 59) reviewed for communication and sensory care. This placed residents at risk for unmet vision and hearing needs.
- D Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure the resident environment was free of potential fire hazards for 1 of 1 sampled resident (#15) reviewed for accidents. This placed residents at risk for injury and exposure to a fire.
- D Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Inspectors wroteBased on interview and record review it was determined the facility failed to respond to pharmacy recommendations for 3 of 5 sampled residents (#s 15, 20, and 27) reviewed for unnecessary medications. This placed residents at risk for potential adverse consequences related to medications and lack of medication oversight.
- D Ensure each resident’s drug regimen must be free from unnecessary drugs.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure antipsychotic and psychotropic medications were clinically indicated, adequately monitored for effectiveness and routinely assessed for appropriate use for 1 of 5 sampled residents (# 26) reviewed for medications. This placed residents at risk for adverse medication consequences and receiving unnecessary medications.
- D 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.
Inspectors wrote2. Resident 27 was admitted to the facility in 2/2022 with diagnoses including Alzheimer's disease. A 5/2023 Consultant Pharmacist's Medication Regimen Review of Resident 27's medications revealed the following: - The resident has been taking haloperidol (antipsychotic medication) twice daily since 9/27/23. Please evaluate the current dose and consider a dose reduction to haloperidol every afternoon. Resident 27's 6/27/23 Annual MDS revealed the resident was severely cognitively impaired, had no mood symptoms or behaviors and received haloperidol. Resident 27's 9/2022 through 8/2023 physician orders included haloperidol 0.25mg twice daily. Resident 27's 9/2022 through 8/2023 MARs revealed the resident received haloperidol 0.25mg twice daily. Review of Resident 27's health record revealed no evidence to indicate a GDR for haloperidol was attempted as required. [...]
- D Provide routine and 24-hour emergency dental care for each resident.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure routine dental services were provided for 1 of 4 sampled residents (#62) reviewed for dental care needs. This placed residents at risk for unmet dental needs.
- D Provide or obtain dental services for each resident.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to ensure routine dental services were provided for 3 of 4 sampled residents (#s 4, 30 & 59) reviewed for dental care needs. This placed residents at risk for unmet dental needs.
- D Ensure each resident receives and the facility provides food that accommodates resident allergies, intolerances, and preferences, as well as appealing options.
Inspectors wroteBased on observation, interview and record review it was determined the facility failed to accommodate resident food choices for 1 of 1 sampled resident (#30) reviewed for choices. This placed residents at risk for food choices not being honored.
Fire safety inspections
31 fire safety citations on file: 5 on May 22, 2026, 10 on January 17, 2025, 16 on August 14, 2023.
Every fire safety citation31 citations
- F Keep aisles, corridors, and exits free of obstruction in case of emergency.
- F Properly select, install, inspect, or maintain portable fire extinguishes.
- F Install smoke barrier doors that can resist smoke for at least 20 minutes.
- F Have simulated fire drills held at unexpected times.
- F Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- F Develop Emergency Preparedness policies and procedures.
- F Establish policies and procedures including evacuation.
- F Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Have simulated fire drills held at unexpected times.
- F Have generator or other power source capable of supplying service within 10 seconds.
- D Provide properly protected cooking facilities.
- D Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- D Provide a written emergency evacuation plan.
- D To conduct inspection, testing and maintenance of fire doors by qualified individuals.
- F Address subsistence needs for staff and patients.
- F Provide a means of sharing information on occupancy/needs.
- F Conduct testing and exercise requirements.
- F Add doors in an exit area that do not require the use of a key from the exit side unless in case of special locking arrangements.
- F Install a fire alarm system that can be heard throughout the facility.
- F Have an alternate power supply for its alarm system.
- F Have approved installation, maintenance and testing program for fire alarm systems.
- F Inspect, test, and maintain automatic sprinkler systems.
- F Properly select, install, inspect, or maintain portable fire extinguishes.
- F Have simulated fire drills held at unexpected times.
- F Have posted "No-smoking" signs in areas where smoking is not permitted or ashtrays provided where smoking was allowed.
- F Have generator or other power source capable of supplying service within 10 seconds.
- D Ensure smoke barriers are constructed to a 1 hour fire resistance rating.
- D To conduct inspection, testing and maintenance of fire doors by qualified individuals.
- D Have power receptacles that are properly grounded.
- D Ensure proper usage of power strips and extension cords.
Fines and payment denials
| Date | Penalty | Amount or length |
|---|---|---|
| June 17, 2024 | Fine | $24,193 |
| November 9, 2023 | Fine | $8,190 |
A payment denial means Medicare and Medicaid stopped paying for new admissions for that period.
Staffing
Hours of care per resident per day, from the payroll records every home sends CMS. Higher means more staff time with each resident.
| Measure | This home | Oregon | United States |
|---|---|---|---|
| All nursing staff (RN, LPN and aides) | 5.24 | 5.03 | 3.86 |
| Registered nurses | 0.42 | 0.72 | 0.69 |
| All nursing staff on weekends | 4.69 | 4.51 | 3.42 |
| Nurse aides | 3.56 | ||
| Licensed practical nurses | 1.25 | ||
| Nursing staff turnover (share who left in a year) | 64.5% | 47.4% | 45.8% |
| Registered nurse turnover | 71.4% | 51.6% | 42.9% |
| Administrators who left | 0 |
CMS expects 3.12 hours a day for residents as sick as this home's (its case-mix figure). The staffing star compares the two.
Staffing by quarter, from daily payroll records
Every nursing home sends CMS its staff hours for each day (the Payroll Based Journal). Here they are added up by quarter. The latest quarter is the one behind the figures above. In January to March 2026, nursing staff hours per resident were 5.46 on weekdays and 4.69 on weekends, 14% lower on weekends (nationally, weekends ran 15% lower). Contract or agency staff worked 1.7% of nursing hours, against 5.3% nationally. Total nursing hours per resident went from 5.16 in April to June 2025 to 5.24 in January to March 2026.
| Quarter | All nursing staff | Registered nurses | Weekdays | Weekends | Contract staff share | Days with no RN hours | Residents a day |
|---|---|---|---|---|---|---|---|
| Jan to Mar 2026 | 5.24 | 0.42 | 5.46 | 4.69 | 1.7% | 0 of 90 | 79 |
| Oct to Dec 2025 | 5.43 | 0.52 | 5.55 | 5.12 | 1.4% | 0 of 92 | 79 |
| Jul to Sep 2025 | 4.95 | 0.50 | 5.07 | 4.65 | 3.9% | 0 of 92 | 82 |
| Apr to Jun 2025 | 5.16 | 0.67 | 5.27 | 4.87 | 7.6% | 0 of 91 | 83 |
| United States, Jan to Mar 2026 | 3.75 | 0.62 | 3.92 | 3.33 | 5.3% | 0.5% of days | |
| Oregon, Jan to Mar 2026 | 4.91 | 0.64 | 5.12 | 4.40 | 6.2% | 0.4% of days |
Hours per resident per day: staff hours in the quarter divided by resident days (the daily census CMS derives from resident assessments). Registered nurses include the director of nursing and RNs with administrative duties; aides include nurse aides in training and medication aides, as in CMS's own staffing measure. How these are calculated.
Quality measures
The measures CMS uses for the quality star. Lower is better for every one of them.
| Measure | This home | Oregon | US |
|---|---|---|---|
| Percentage of long-stay residents whose need for help with daily activities has increased Long Stay residents, 2025Q2-2026Q1 | 15.0 | 14.9 | 13.9 |
| Percentage of long-stay residents with a catheter inserted and left in their bladder Long Stay residents, 2025Q2-2026Q1 | 1.4 | 1.4 | 0.8 |
| Percentage of long-stay residents with a urinary tract infection Long Stay residents, 2025Q2-2026Q1 | 0.3 | 2.0 | 1.6 |
| Percentage of long-stay residents experiencing one or more falls with major injury Long Stay residents, 2025Q2-2026Q1 | 1.1 | 2.4 | 3.2 |
| Percentage of short-stay residents who newly received an antipsychotic medication Short Stay residents, 2025Q2-2026Q1 | 1.6 | 1.4 | 1.6 |
| Percentage of long-stay residents whose ability to walk independently worsened Long Stay residents, 2025Q2-2026Q1 | 12.7 | 20.6 | 14.1 |
| Percentage of long-stay residents with pressure ulcers Long Stay residents, 2025Q2-2026Q1 | 6.9 | 5.8 | 4.6 |
| Percentage of long-stay residents who received an antipsychotic medication Long Stay residents, 2025Q2-2026Q1 | 15.6 | 13.9 | 15.4 |
Owners and operators
Legal business name: SAPPHIRE AT CEDAR CROSSINGS, LLC. CMS links this home to Sapphire Health Services, a group of 8 nursing homes averaging 2.1 stars overall.
| Name | Role | Type | Share | Since |
|---|---|---|---|---|
| Becker, Andrew | 5% or greater direct ownership interest | Individual | 30% | 06/01/2020 |
| Hilty, Lisa | 5% or greater direct ownership interest | Individual | 25% | 06/01/2020 |
| Morris, Bryan | 5% or greater direct ownership interest | Individual | 5% | 06/01/2020 |
| Ricker, Kevin | 5% or greater direct ownership interest | Individual | 40% | 07/01/2020 |
| Sapphire Healthcare Srvs. | Operational/managerial control | Organization | 01/04/2021 | |
| Ames, Deborah | Operational/managerial control | Individual | 01/01/2025 | |
| Meeko, Mary | Operational/managerial control | Individual | 07/15/2024 | |
| Sapphire Healthcare Srvs. | Adp of the SNF | Organization | 04/16/2025 | |
| Ames, Deborah | Adp of the SNF | Individual | 01/01/2025 | |
| Becker, Andrew | Adp of the SNF | Individual | 05/01/2024 | |
| Hilty, Lisa | Adp of the SNF | Individual | 05/01/2024 | |
| Meeko, Mary | Adp of the SNF | Individual | 07/23/2024 | |
| Morris, Bryan | Adp of the SNF | Individual | 05/01/2024 | |
| Ricker, Kevin | Adp of the SNF | Individual | 05/01/2024 |
As listed in the CMS ownership file, which names owners with a 5% or greater stake and the people and companies with operational or managerial control.
Questions to ask on a visit
Chosen from this home's own inspection record.
- How do you prevent falls and pressure injuries, and how are families told when one happens?Inspectors cited 18 problems in this area, most recently on May 22, 2026: "Assist a resident in gaining access to vision and hearing services."
- How do residents and families raise a complaint or grievance, and how fast is it answered?Inspectors cited 11 problems in this area, most recently on May 22, 2026: "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."
- How are medications reviewed, and how often are antipsychotic or sedating drugs used?Inspectors cited 9 problems in this area, most recently on May 22, 2026: "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."
- When is the care plan meeting, and can family attend it?Inspectors cited 6 problems in this area, most recently on May 22, 2026: "Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted"
Other nursing homes nearby
- Cascade Terrace Post Acute Portland, 1 mi · 1 of 5 stars · 46 citations
- Avalon Care Center - Portland Portland, 1.2 mi · 3 of 5 stars · 32 citations
- Gracelen Care Center Portland, 2 mi · 1 of 5 stars · 58 citations
- Secora Rehabilitation of Cascadia Portland, 2.1 mi · 3 of 5 stars · 37 citations
- Village Health Care Gresham, 2.2 mi · 2 of 5 stars · 44 citations
- Portland Health and Rehabilitation Portland, 2.9 mi · 1 of 5 stars · 55 citations
- Marquis Mill Park Portland, 3 mi · 3 of 5 stars · 17 citations
- Menlo Park Post Acute Portland, 3.5 mi · 2 of 5 stars · 36 citations
Oregon contacts for a concern about a nursing home
These are the official offices in Oregon. NursingHomeClear cannot take or act on complaints.
- Inspections and complaints: Oregon Department of Human Services, Nursing Facility Licensing, the state agency that inspects nursing homes for CMS and takes complaints about care.
- Resident advocate: Oregon Office of the Long-Term Care Ombudsman, (800) 522-2602. The long-term care ombudsman is a free, confidential advocate for residents and families, set up under the federal Older Americans Act.
- State inspection reports: Oregon Licensed Long-Term Care Settings Search, where Oregon publishes its own records on licensed homes.
Common questions
- What is Cedar Crossings's Medicare star rating?
- CMS rates Cedar Crossings 3 out of 5 stars overall, with 2 for health inspections, 3 for staffing and 5 for quality measures (CMS data as of September 1, 2026).
- How many deficiencies did Cedar Crossings get at its last inspection?
- 8 health deficiencies at the standard inspection on May 22, 2026. The Oregon average is 9.2.
- Has Cedar Crossings been fined?
- Yes. CMS lists 2 fines totaling $32,383 in the last three years.
- Does Cedar Crossings accept Medicaid?
- It is certified to take Medicaid (CMS lists it as "Medicare and Medicaid"). Certification does not mean a Medicaid bed is open: ask the admissions office.
- Who owns Cedar Crossings?
- CMS lists 14 owners and managers, and links the home to Sapphire Health Services. Legal business name: SAPPHIRE AT CEDAR CROSSINGS, LLC.
Sources
- Ratings, staffing and fines: CMS Provider Information, released September 30, 2026, data as of September 1, 2026.
- Citations: CMS Health Deficiencies and Fire Safety Deficiencies.
- Owners: CMS Ownership. Penalties: CMS Penalties.
- Staffing by quarter: CMS Payroll Based Journal Daily Nurse Staffing, April 2025 to March 2026, summed by NursingHomeClear.
- Inspector summaries: CMS Full Statement of Deficiencies (CMS-2567 text), data as of September 1, 2026. Each quote is the part of the statement before the detailed findings.
- Inspection reports with the inspectors' full notes are on this home's Medicare.gov page.
- Something wrong on this page? Ask for a correction. We fix errors in our copy of the data; findings themselves can only be changed by CMS and the state.
- NursingHomeClear is independent and not affiliated with CMS, Medicare or any state agency. This page reports federal records; it does not rate, recommend or endorse any home, and it is not medical or legal advice.