Willow Creek Post Acute
175 NE 16TH STREET, Madras, OR, 97741
No. Federal inspectors recorded no deficiencies against Willow Creek Post Acute in Madras, Oregon at its most recent standard inspection on 2026-02-12. 1 finding has been recorded at the actual-harm level. Medicare rates it 3 out of 5 overall.
Every deficiency on record, by how serious CMS judged it
CMS grades each finding from A to L on two axes: how badly residents were affected, and how many. These are its bands, not ours. The figures cover every standard and complaint survey on record, which is a longer window than the rating cycle above.
The last 17 findings, newest first
Each is the federal requirement the home was found not to meet, in CMS’s own wording, with the tag number so it can be looked up against the inspection report.
Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards.
Nutrition and Dietary Deficiencies · F0812 · 2024-10-09 · standard survey · No actual harm, potential for more than minimal harm
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.
Pharmacy Service Deficiencies · F0761 · 2024-10-09 · standard survey · No actual harm, potential for more than minimal harm
Provide appropriate pressure ulcer care and prevent new ulcers from developing.
Quality of Life and Care Deficiencies · F0686 · 2024-07-11 · from a complaint · No actual harm, potential for more than minimal harm
Provide safe, appropriate pain management for a resident who requires such services.
Quality of Life and Care Deficiencies · F0697 · 2023-06-30 · standard survey · Actual harm to a resident
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.
Nursing and Physician Services Deficiencies · F0727 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Make sure that a working call system is available in each resident's bathroom and bathing area.
Environmental Deficiencies · F0919 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Put firmly secured handrails on each side of hallways.
Environmental Deficiencies · F0924 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
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.
Resident Rights Deficiencies · F0584 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Provide care and assistance to perform activities of daily living for any resident who is unable.
Quality of Life and Care Deficiencies · F0677 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Provide appropriate treatment and care according to orders, resident’s preferences and goals.
Quality of Life and Care Deficiencies · F0684 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Provide appropriate colostomy, urostomy, or ileostomy care/services for a resident who requires such services.
Quality of Life and Care Deficiencies · F0691 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Provide safe and appropriate respiratory care for a resident when needed.
Quality of Life and Care Deficiencies · F0695 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Post nurse staffing information every day.
Nursing and Physician Services Deficiencies · F0732 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
Ensure a licensed pharmacist perform a monthly drug regimen review, including the medical chart, following irregularity reporting guidelines in developed policies and procedures.
Pharmacy Service Deficiencies · F0756 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
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.
Pharmacy Service Deficiencies · F0758 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
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.
Nutrition and Dietary Deficiencies · F0803 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
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.
Nutrition and Dietary Deficiencies · F0808 · 2023-06-30 · standard survey · No actual harm, potential for more than minimal harm
How CMS scores this home
These stars are Medicare’s, not ours — we publish no rating of our own. They are reproduced here because they are part of the public record.
Who owns Willow Creek Post Acute
Nursing homes are frequently owned through layers of companies, and the name over the door is rarely the one that holds the licence. This is the ownership CMS has on file.
| Owner | Role | Share | Since |
|---|---|---|---|
| BROWNOR ENTERPRISES INC | Organization | 6% | since 02/27/2007 |
| CDK, LLC | Organization | 32% | since 02/27/2007 |
| GILL FAMILY TRUST | Organization | 9% | since 02/27/2007 |
| BRAAKSMA, JUDY | Individual | 7% | since 02/27/2022 |
| BROWN, JANA | Individual | NO PERCENTAGE PROVIDED | since 02/27/2007 |
| BUNZA, GEOFFREY | Individual | 6% | since 02/27/2007 |
| JUDY, RONALD | Individual | 7% | since 02/27/2022 |
| MASON, CHRISTIAN | Individual | 9% | since 02/27/2007 |
| NG, KELVIN | Individual | 5% | since 02/27/2007 |
| NG, PETER | Individual | 8% | since 02/27/2007 |
| REMLEY, MARK | Individual | NOT APPLICABLE | since 11/01/2020 |
| AIDAN HEALTH SERVICES INC | Organization | NOT APPLICABLE | since 11/01/2020 |
Ask Willow Creek Post Acute a question
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Source: Centers for Medicare & Medicaid Services, Nursing Home Care Compare. Retrieved 2026-07-29. Facility number 385181.
Figures reproduce the state’s own totals and are not re-aggregated. Methodology · Report a correction