Above average — CMS composite of the measures below.
The next survey window likely opens around February 2027
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Mirabella Portland during CMS and state inspections, most recent first.
Delayed completion of fall investigations: A resident with heart disease had two falls, including one unwitnessed fall and one witnessed fall while being assisted to bed. Although the facility policy required incident investigations to be completed within five working days, the investigations were completed well after that timeframe, with the DNS and Administrator acknowledging the delay and describing the expected process for initiating and completing the reviews.
The facility failed to provide bed hold policy notice to a resident or representative and failed to notify the State LTC Ombudsman of hospital discharges for two residents. One resident had pulmonary embolism, vascular dementia, moderate cognitive impairment, flank pain, and low O2 saturation before transfer to the hospital, and the other resident with a hip replacement was transported to the hospital and did not return. Staff stated the bed hold policy was not given and the Ombudsman was not contacted.
Failure to assist a resident with glasses. A resident with severe cognitive impairment, aphasia, and dependence for ADLs was observed multiple times without glasses during activities and while in the room, even though the glasses were kept in the case on the dresser shelf. CNAs stated the resident could not ask for help and were unaware the resident needed to wear glasses, while the RN and DNS confirmed the resident needed staff assistance to place and remove them.
A resident at high risk for falls, with dementia, experienced a fall during a standing transfer due to the failure of a CNA to use a gait belt and follow specific turning instructions. The CNA was unaware of the fall prevention techniques outlined in the updated CNA Pocket Guide, which contributed to the incident.
Delayed Completion of Fall Investigations
Penalty
Summary
The facility failed to ensure that a resident’s fall investigations were completed timely for one resident reviewed. The resident was admitted in 8/2022 with a diagnosis of heart disease. The facility’s Abuse and Incident Reporting Policy and Procedure, revised in 5/2024, stated that an investigation was to be completed within five working days after an incident was reported. The resident had an unwitnessed fall on 10/8/25 after trying to move a swivel chair, losing balance, and falling. The investigation stated that the resident’s care plan was followed and that abuse and neglect were ruled out two hours after the incident, but the investigation was not completed until 11/1/25. The resident also had a witnessed fall on 11/21/25 while being assisted to bed; the fall investigation was completed by the DNS on 12/2/25 and signed off by the Administrator on 12/16/25. The DNS and Administrator stated investigations were to be completed and submitted within five days, and the Administrator stated nurses were to initiate the investigation, obtain witness interviews, implement new interventions if indicated, notify the DNS, and complete the investigation with root cause analysis before final review.
Failure to Provide Bed Hold Notice and Notify Ombudsman After Hospital Discharges
Penalty
Summary
The facility failed to ensure that the resident or representative was provided the bed hold policy and failed to notify the State Long Term Care Ombudsman of residents’ discharges for 2 of 2 sampled residents reviewed for hospitalization. Resident 4 was admitted to the facility in 5/2024 with diagnoses including pulmonary embolism without acute cor pulmonale and vascular dementia, and the 1/21/26 annual MDS showed moderate cognitive impairment. The resident was sent to the hospital for left flank pain and decreased blood oxygen saturation, but the record contained no evidence that the facility notified the State Long Term Care Ombudsman of the discharge or provided the resident or representative with a copy of the bed hold policy. Staff 9 stated she made the decision to send Resident 4 to the hospital after speaking with the provider and family representative, and stated she did not provide the bed hold policy or contact the Ombudsman. A family member stated the facility did not provide a bed hold notification when the resident was discharged to the hospital. For Resident 27, who was admitted in 12/2025 with a diagnosis of left hip replacement, the clinical record showed the resident was transported to the hospital and did not return to the facility, with no documentation that the Ombudsman office was notified. The Administrator stated staff did not notify the Ombudsman when residents were discharged to the hospital unless the discharge was involuntary, and the Social Services Director stated she did not notify the Ombudsman for Resident 27.
Failure to Assist Resident With Glasses
Penalty
Summary
The facility failed to ensure a resident was assisted to wear glasses. Resident 13 was admitted with diagnoses including intracranial injury with loss of consciousness and aphasia. The resident’s care plan dated 1/2/20 directed staff to ensure the resident’s glasses were available to support participation in activities and to provide assistance to place and remove them. The 1/21/26 annual MDS indicated the resident had severe cognitive impairment, was dependent on staff for assistance with ADLs including dressing and personal hygiene, and had adequate vision with the use of glasses. During observations from 3/23/26 through 3/26/26, the resident was seen in the living room with other residents, during group activities, and while sitting in the resident’s room without wearing glasses, while the glasses were observed in the case on the shelf above the dresser. Staff interviews showed multiple CNAs were aware the resident was completely dependent on staff and unable to ask for help, but they were not aware the resident needed to wear glasses or did not think the resident wore them. An RN stated the resident had glasses and wore them occasionally, and the DNS stated the resident’s spouse wanted the resident to wear the glasses and staff were expected to assist because the resident could not place or remove them or communicate requests.
Failure to Follow Fall Prevention Techniques
Penalty
Summary
The facility failed to adhere to fall prevention techniques for a resident identified as high risk for falls. The resident, admitted in July 2020 with a diagnosis of dementia, was assessed on October 23, 2024, as being at high risk for falls. According to the CNA Pocket Guide updated on November 18, 2024, the resident required assistance from one person using a front wheel walker (FWW) and a gait belt, with a specific instruction to turn clockwise when possible. On November 19, 2024, the resident was observed being assisted by a CNA during a standing transfer without a gait belt and turning counter-clockwise, resulting in the resident falling backwards onto the ground. The CNA admitted to not being aware of the specific fall prevention instructions for the resident, and the DNS confirmed that the CNA Pocket Guide was updated daily and provided to staff at the start of their shifts. The resident did not sustain a significant injury from the fall, but the failure to use a gait belt and follow the turning instructions contributed to the incident.
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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 Portland
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Reedwood Post Acute | 1.9 mi | ★★★★★ | 0 | 0 |
| The Creston Health & Rehabilitation | 2 mi | ★★★★★ | 13 | 0 |
| Avamere Crestview Of Portland | 2.4 mi | ★★★★★ | 11 | 0 |
| Laurelhurst Post Acute & Rehabilitation | 2.4 mi | ★★★★★ | 3 | 0 |
| Holladay Park Plaza | 2.6 mi | ★★★★★ | 4 | 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 July 2026) and official state health department websites.