Violation Details: 00033693-AP-023730

Records Request Print
Date
6/1/2019
Report number
00033693-AP-023730
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide safe environment
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(r)
External site: 411-054-0030(1)(e)(I)
Findings
The Alleged Victim (AV) was a known fall risk and was in the facility for that reason. On or about #June 1, 2019, AV got up from his/her chair to go to bed and fell causing in jury to his/her face. AV pressed his/her call button at approximately 3:22 am, and claims to have laid on the floor for approximately one hour before Alleged Perpetrator #2 (AP2) responded to the pendant call. AV experienced unreasonable discomfort during this wait. AP2's actions are considered neglect of care and constitute abuse. The facility failed to ensure a safe environment which is a violation of Oregon Administrative Rules.