The Pearl at Kruse Way — nursing home in Lake Oswego, OR

Facility type: Nursing home · SNF / NF
CMS provider type: Medicare and Medicaid
Certified beds: 74 CMS-certified beds (not state-licensed beds)
Licensed beds: State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead.
Average residents per day: 40.6 CMS, MDS-derived
CMS Certification Number: 385271
Certification status: Active CMS certification Verified
First approved (Medicare/Medicaid): Jan 25, 2006
Ownership type: For profit - Limited Liability company
Operator (legal business name): Avamere Lake Oswego Operations Investors, LLC
CMS chain: Avamere 27 facilities
Phone: (503) 675-6055
Resident & family council: Resident
Sprinklers in all required areas: Yes
Official profile: Medicare Care Compare ↗

Inspection record · CMS window

Verified

Inspections

8

latest Nov 21, 2025

Citations

31

22 health · 9 fire

Harm or worse

0

no immediate jeopardy

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D15	E7	F9
Minimal	A·	B·	C·

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

CMS Five-Star ratings

Federal · CMS

Overall

Health inspections

Staffing

Quality measures

Penalties · about the last 3 years

Fines

0

$0

Payment denials

0

Latest

—

Federal certification

Federal · CMS

Authority: Centers for Medicare & Medicaid Services (CMS), surveyed by the state survey agency
CCN: 385271
Program: Medicare and Medicaid
Medicare (SNF): Certified
Medicaid (NF): Certified
Certified beds: 74
First approved: Jan 25, 2006
Located in a hospital: No
Status: Active CMS certification as of CMS release Oct 1, 2026
Evidence: Verified

State license

State licensure is issued by the state survey agency. State license records are not yet ingested for this facility; the federal CMS certification is shown instead. State coverage for Oregon.

Federal certification and the state license are different records. A nursing home is licensed by the state and, separately, certified by CMS to bill Medicare and/or Medicaid. We link them by the CCN when the state publishes it; otherwise by exact address, house number and street, or exact name within the same ZIP, and label that link as inferred. Never by name alone.

CMS publishes about the three most recent standard surveys plus complaint and infection-control inspections from the prior three years. Older findings leave the dataset; their absence is not evidence they never happened.

Date	Domain	Survey types	Citations	Most severe	Open
Nov 21, 2025	Fire safety	Fire Safety Standard	1	Potential harm	—	Open →
Nov 21, 2025	Health	Health Standard	2	Potential harm	—	Open →
Jan 23, 2025	Health	Health Complaint	2	Potential harm	—	Open →
Aug 2, 2024	Fire safety	Fire Safety Standard	2	Potential harm	—	Open →
Aug 2, 2024	Health	Health Standard	5	Potential harm	—	Open →
Jun 27, 2024	Health	Health Complaint	2	Potential harm	—	Open →
Jul 14, 2023	Fire safety	Fire Safety Standard	6	Potential harm	—	Open →
Jul 14, 2023	Health	Health Standard	11	Potential harm	—	Open →

Enforcement

Penalties

Civil money penalties and denials of payment for new admissions, as published by CMS (about the last three years). Amounts may change on appeal.

No fines or payment denials in the CMS Penalties file for this CCN.

Scope × severity

Severity	Isolated	Pattern	Widespread
Immediate jeopardy	J·	K·	L·
Actual harm	G·	H·	I·
Potential harm	D15	E7	F9
Minimal	A·	B·	C·

By concept

Date	Tag	Deficiency	Scope / severity	Correction	Flags
Nov 21, 2025	E-0041	Implement emergency and standby power systems. Emergency Preparedness Deficiencies · Emergency preparedness	F · Potential harm Widespread	Corrected Dec 22, 2025
Nov 21, 2025	F-0628	Provide the required documentation or notification related to the resident's needs, appeal rights, or bed-hold policies. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Dec 25, 2025
Nov 21, 2025	F-0761	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 · Medication management	D · Potential harm Isolated	Corrected Dec 25, 2025
Jan 23, 2025	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Feb 17, 2025	Complaint
Jan 23, 2025	F-0686	Provide appropriate pressure ulcer care and prevent new ulcers from developing. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Feb 17, 2025	Complaint
Aug 2, 2024	K-0712	Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 2, 2024
Aug 2, 2024	K-0932	Meet other general requirements. Smoke Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 2, 2024
Aug 2, 2024	F-0552	Ensure that residents are fully informed and understand their health status, care and treatments. Resident Rights Deficiencies · Resident rights & abuse/neglect	D · Potential harm Isolated	Corrected Sep 10, 2024
Aug 2, 2024	F-0655	Create and put into place a plan for meeting the resident's most immediate needs within 48 hours of being admitted Resident Assessment and Care Planning Deficiencies · Clinical care	E · Potential harm Pattern	Corrected Sep 10, 2024
Aug 2, 2024	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	E · Potential harm Pattern	Corrected Sep 10, 2024
Aug 2, 2024	F-0761	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 · Medication management	E · Potential harm Pattern	Corrected Sep 10, 2024
Aug 2, 2024	F-0812	Procure food from sources approved or considered satisfactory and store, prepare, distribute and serve food in accordance with professional standards. Nutrition and Dietary Deficiencies · Food, nutrition & hydration	E · Potential harm Pattern	Corrected Sep 10, 2024
Jun 27, 2024	F-0684	Provide appropriate treatment and care according to orders, resident’s preferences and goals. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jul 17, 2024	Complaint
Jun 27, 2024	F-0689	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Jul 17, 2024	Complaint
Jul 14, 2023	K-0211	Keep aisles, corridors, and exits free of obstruction in case of emergency. Egress Deficiencies · Environment & life safety	D · Potential harm Isolated	Corrected Aug 30, 2023
Jul 14, 2023	K-0324	Provide properly protected cooking facilities. Smoke Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 30, 2023
Jul 14, 2023	K-0345	Have approved installation, maintenance and testing program for fire alarm systems. Smoke Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 30, 2023
Jul 14, 2023	K-0353	Inspect, test, and maintain automatic sprinkler systems. Smoke Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 30, 2023
Jul 14, 2023	K-0712	Have simulated fire drills held at unexpected times. Miscellaneous Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 30, 2023
Jul 14, 2023	K-0918	Have generator or other power source capable of supplying service within 10 seconds. Gas, Vacuum, and Electrical Systems Deficiencies · Environment & life safety	F · Potential harm Widespread	Corrected Aug 30, 2023
Jul 14, 2023	F-0584	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 · Resident rights & abuse/neglect	E · Potential harm Pattern	Corrected Aug 30, 2023
Jul 14, 2023	F-0656	Develop and implement a complete care plan that meets all the resident's needs, with timetables and actions that can be measured. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Aug 30, 2023
Jul 14, 2023	F-0657	Develop the complete care plan within 7 days of the comprehensive assessment; and prepared, reviewed, and revised by a team of health professionals. Resident Assessment and Care Planning Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Aug 30, 2023
Jul 14, 2023	F-0689	Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Aug 30, 2023
Jul 14, 2023	F-0698	Provide safe, appropriate dialysis care/services for a resident who requires such services. Quality of Life and Care Deficiencies · Clinical care	D · Potential harm Isolated	Corrected Oct 13, 2023
Jul 14, 2023	F-0725	Provide enough nursing staff every day to meet the needs of every resident; and have a licensed nurse in charge on each shift. Nursing and Physician Services Deficiencies · Staffing & supervision	F · Potential harm Widespread	Corrected Oct 13, 2023
Jul 14, 2023	F-0730	Observe each nurse aide's job performance and give regular training. Nursing and Physician Services Deficiencies · Staffing & supervision	D · Potential harm Isolated	Corrected Aug 30, 2023
Jul 14, 2023	F-0732	Post nurse staffing information every day. Nursing and Physician Services Deficiencies · Staffing & supervision	E · Potential harm Pattern	Corrected Oct 13, 2023
Jul 14, 2023	F-0865	Have a plan that describes the process for conducting QAPI and QAA activities. Administration Deficiencies · Administration & records	F · Potential harm Widespread	Corrected Aug 20, 2023
Jul 14, 2023	F-0880	Provide and implement an infection prevention and control program. Infection Control Deficiencies · Infection prevention	E · Potential harm Pattern	Corrected Aug 30, 2023
Jul 14, 2023	F-0947	Ensure nurse aides have the skills they need to care for residents, and give nurse aides education in dementia care and abuse prevention. Nursing and Physician Services Deficiencies · Staffing & supervision	D · Potential harm Isolated	Corrected Aug 30, 2023

“Corrected” does not erase a citation: the historical finding stays listed with its disposition. Narrative statements of deficiencies are not part of the CMS dataset; see Care Compare for the official inspection report.

Five-Star ratings

Federal · CMS

Overallstate 3.2

Health inspectionsstate 2.8

Staffingstate 3.9

Quality measuresstate 3.7

Long-stay QMNot rated

Short-stay QM

CMS ratings apply to CMS-certified nursing homes only and are relative within each state. They are not a guarantee of any individual resident’s experience.

Nurse staffing · hours per resident per day

Total nurse staffing5.82

State avg 5.13US avg 3.90

Registered nurse (RN)1.23

State avg 0.76US avg 0.69

Licensed practical nurse1.15

State avg 0.89US avg 0.86

Nurse aide3.44

State avg 3.48US avg 2.35

Weekend total nurse5.06

State avg 4.56US avg 3.43

Reported from Payroll-Based Journal (PBJ) data, as published by CMS. Case-mix adjusted total: 5.61 (case-mix index 1.45).

Staff turnover

Total nursing staff turnover57.7%

State avg 43.5%US avg 45.3%

Registered nurse turnover66.7%

State avg 49.5%US avg 42.5%

Administrators who left1

State avg 1US avg 1

Health survey score

Cycle 1 standard survey: Nov 21, 2025
Cycle 1 health score: 8
Total weighted score: 19

Operating entity

Avamere Lake Oswego Operations Investors, LLC

CMS legal business name of the certified provider. Operates this facility only.

VerifiedLinked by exact legal name

CMS chain

Avamere

27 facilities in 2 states. CMS chain ID 58.

VerifiedAssigned by CMS

Chain average overall rating (CMS): 3.3

Ownership disclosures

Disclosures

4

Organizations

0

Individuals

4

CMS Ownership file

All disclosed roles

Operator, owners, managers, officers and lenders are distinct roles and are never flattened into one entity. Organizations link across facilities by exact normalized legal name; individuals are listed per facility only.

Name	Type	Role (Carefield group)	CMS role text	Share	Since
Mary Kofstad	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Feb 13, 2024
Andrew Simpson	Individual	Corporate officer / director	CORPORATE OFFICER	not provided	Jun 1, 2024
Kirsten Carr	Individual	Managing employee	CONTRACTED MANAGING EMPLOYEE	not provided	Apr 1, 2022
Erik Margolis	Individual	Managing employee	W-2 MANAGING EMPLOYEE	not provided	Apr 10, 2024

Same chain in Oregon

All 26 in chain →

Facility	Beds	Last inspection	Citations (window)	Fines
Avamere Health Services of Rogue Valley 625 Stevens Street, Medford, OR 97504 CCN 385024	91	Aug 22, 2025	55	—
Avamere Crestview of Portland 6530 SW 30th Avenue, Portland, OR 97239 CCN 385031	127	Feb 13, 2026	601 IJ2 harm	—
Avamere Rehabilitation of Eugene 2360 Chambers Street, Eugene, OR 97405 CCN 385053	92	Mar 30, 2026	621 IJ	$36k
Avamere Rehabilitation of Oregon City 1400 Division Street, Oregon City, OR 97045 CCN 385125	111	Aug 29, 2025	753 harm	$86k
Avamere at Three Fountains 835 Crater Lake Avenue, Medford, OR 97504 CCN 385126	117	Jul 9, 2026	372 harm	—
Avamere Rehabilitation of King City 16485 SW Pacific Highway, Tigard, OR 97224 CCN 385132	148	Aug 13, 2026	47	—
Avamere Rehabilitation of Newport 835 SW 11th Street, Newport, OR 97365 CCN 385162	52	Aug 8, 2025	39	—
Avamere Rehabilitation of Lebanon 350 S. 8th, Lebanon, OR 97355 CCN 385168	84	May 12, 2026	741 IJ	$20k

No building or property record is linked to this facility yet. Parcel, assessor and building-permit joins will be added only where a valid site match exists.

Coordinates as published by CMS.

Address: 4550 Carman Drive, Lake Oswego, OR 97035
ZIP: 97035
County: Clackamas County FIPS 41005
State: Oregon
Urban / rural (CMS): Urban

Within ~25 km

Nearby nursing homes

Facility	Distance	Beds	Last inspection	Citations (window)	Fines
Tigard Rehabilitation and Care 14145 SW 105th Avenue, Tigard, OR 97224 CCN 385272SFF Candidate	5.5 km	112	May 11, 2026	643 IJ	$58k
Fernwood Supportive Living at Madrona Grove 13505 SE River Road, Portland, OR 97222 CCN 38A031	5.5 km	16	Jun 4, 2026	32	—
Willamette View Health Center 13145 SE River Road, Milwaukie, OR 97222 CCN 385200	5.5 km	6	Jun 17, 2026	15	—
West Hills Health & Rehabilitation 5701 SW Multnomah Blvd, Portland, OR 97219 CCN 385112	5.6 km	180	Apr 25, 2025	341 harm	$13k
Marquis Tualatin Post Acute Rehab 19945 SW Boones Ferry Road, Tualatin, OR 97062 CCN 385279	6.2 km	54	May 22, 2026	18	—
Avamere Crestview of Portland 6530 SW 30th Avenue, Portland, OR 97239 CCN 385031	6.4 km	127	Feb 13, 2026	601 IJ2 harm	—
Avamere Rehabilitation of King City 16485 SW Pacific Highway, Tigard, OR 97224 CCN 385132	6.6 km	148	Aug 13, 2026	47	—
Marquis Vermont Hills 6010 SW Shattuck Road, Portland, OR 97221 CCN 385218	7.1 km	73	May 22, 2026	27	—

Source	Record	Facts	Evidence	Source release	Retrieved
CMS Provider Information US-CMS	385271	name, address, phone, certification, certified_beds, ownership_type, legal_business_name, chain	Verified	Oct 1, 2026	Nov 7, 2026
CMS Provider Information US-CMS	385271	ratings, staffing, health_survey_score Five-Star ratings and PBJ staffing apply to the CMS-certified universe only.	Verified	Oct 1, 2026	Nov 7, 2026

Record-level source links for CCN 385271

First seen by Carefield Nov 7, 2026 · last changed Nov 7, 2026. This record as JSON · Report a correction