Willow Creek Post Acute

175 Ne 16th Street · Madras, OR · 97741 · 5414752273

20 certified beds For profit - Limited Liability company

  • Staffing hours comfortably above national benchmarks.
  • Inspection results have improved across recent cycles.

Red flags

97% of nursing staff left within a year

High turnover disrupts continuity of care; the national median is 45%.

Score breakdown

Inspection record 30% of score 68
Serious harm & abuse 20% 94
Staffing 20% 82
Federal penalties 15% 62
Trend 10% 92
Context 5% 100

Quality-measure stars are deliberately excluded — they're largely self-reported by facilities. Full method.

CMS ratings & staffing

Overall: 3 of 5 Inspections: 4 of 5 Staffing: 4 of 5 Quality measures: 1 of 5

Total nurse hours / resident-day6.333.48 min · 4.1 strong
RN hours / resident-day1.310.55–0.75
Weekend hours / resident-day5.29≈ weekday level
Nursing turnover / year97%median 45%
Fines (3-yr window)1 · $69,901

Inspection citations (17 in the current record)

  • Potential for harm · E October 9, 2024

    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.

    Corrected November 1, 2024 · Pharmacy Service

  • Potential for harm · F October 9, 2024

    Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.

    Corrected November 1, 2024 · Nutrition and Dietary

  • Potential for harm · D July 11, 2024 · found via complaint

    Provide appropriate pressure ulcer care and prevent new ulcers from developing.

    Corrected August 2, 2024 · Quality of Life and Care

  • Actual harm · G June 30, 2023 · found via complaint

    Provide safe, appropriate pain management for a resident who requires such services.

    Corrected July 19, 2023 · Quality of Life and Care

  • Potential for harm · D June 30, 2023 · found via complaint

    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.

    Corrected August 10, 2023 · Resident Rights

  • Potential for harm · D June 30, 2023 · found via complaint

    Provide care and assistance to perform activities of daily living for any resident who is unable.

    Corrected August 10, 2023 · Quality of Life and Care

  • Potential for harm · D June 30, 2023 · found via complaint

    Provide appropriate treatment and care according to orders, resident’s preferences and goals.

    Corrected August 10, 2023 · Quality of Life and Care

  • Potential for harm · D June 30, 2023 · found via complaint

    Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.

    Corrected August 10, 2023 · Quality of Life and Care

  • Potential for harm · D June 30, 2023 · found via complaint

    Provide safe and appropriate respiratory care for a resident when needed.

    Corrected August 10, 2023 · Quality of Life and Care

  • Potential for harm · E June 30, 2023 · found via complaint

    Have a registered nurse on duty 8 hours a day; and select a registered nurse to be the director of nurses on a full time basis.

    Corrected August 10, 2023 · Nursing and Physician Services

  • Potential for harm · D June 30, 2023 · found via complaint

    Post nurse staffing information every day.

    Corrected August 10, 2023 · Nursing and Physician Services

  • Potential for harm · D June 30, 2023 · found via complaint

    Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.

    Corrected August 10, 2023 · Pharmacy Service

  • Potential for harm · D June 30, 2023 · found via complaint

    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.

    Corrected August 10, 2023 · Pharmacy Service

  • Potential for harm · D June 30, 2023 · found via complaint

    Ensure menus must meet the nutritional needs of residents, be prepared in advance, be followed, be updated, be reviewed by dietician, and meet the needs of the resident.

    Corrected August 10, 2023 · Nutrition and Dietary

  • Potential for harm · D June 30, 2023 · found via complaint

    Ensure therapeutic diets are prescribed by the attending physician and may be delegated to a registered or licensed dietitian, to the extent allowed by State law.

    Corrected August 10, 2023 · Nutrition and Dietary

  • Potential for harm · E June 30, 2023 · found via complaint

    Make sure that a working call system is available in each resident's bathroom and bathing area.

    Corrected September 27, 2022 · Environmental

  • Potential for harm · E June 30, 2023 · found via complaint

    Put firmly secured handrails on each side of hallways.

    Corrected August 10, 2023 · Environmental

Federal penalties

DateTypeAmount / length
June 30, 2023Fine$69,901

Better-scoring options nearby

No better-scoring facility within 25 miles in the current data — this one leads its area. See the whole state.

Family & resident reviews — a separate signal, never mixed into the score

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Source: CMS Care Compare (public domain), data as of June 1, 2026 · CCN 385181 · certified since May 19, 1988. The score is a screen, not a verdict on any one resident's experience — read how it's computed, then visit in person.