Violation Details: 00054065-AP-037815

Records Request Print
Date
10/17/2019
Report number
00054065-AP-037815
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to provide service
Result
Substantiated
Rule(s) Violated
External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0030(1)(e)(I)
External site: 411-054-0036(2)(g)
Findings
The facility failed to implement effective interventions and appropriately monitor the Alleged Victim (AV) according to his/her known needs related to falls and catheter care. On or about October 17, 2019, AV experienced an unwitnessed fall where s/he was found approximately 3.5 hours later with his/her catheter completely removed, causing unreasonable discomfort and a loss of personal dignity. The failure is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP20-00587 $500.00 fine assessed