- Date
- 1/16/2020
- Report number
- 00067131-AP-048572
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- Alleged Victim (AV) had a known history of falls. The facility had multiple interventions in place dated August 7, 2019. The only new intervention to mitigate AV's risk of falls after August 2019 was the addition of a body pillow to AV's bed on January 5, 2020. AV experienced falls on November 13th, 27th, 28th, 30th, December 6th, 2019 and January 5, 2020, some with injuries. On or about January 16, 2020, AV fell trying to take his/her self to the restroom and obtained a bump on the side of the head and some discoloration on his/her forearm. It is unclear if anyone checked on AV before his/her fall. The facility failed to care plan and implement appropriate interventions based on AV's known history of falls, which is a violation of resident rights, is neglect of care and constitutes abuse.
- Sanction
- RCFCP20-01144 $375.00 fine assessed