Violation Details: 00099171-AP-075267

Date
8/1/2020
Report number
00099171-AP-075267
Type
Licensing Violation
Level
3 - Moderate harm or potential for serious harm
Allegation
Failure to provide a system that prevents theft or misuse of medication
Result
Substantiated
Findings
Alleged Victim (AV) was prescribed an as needed oxycodone, take one tablet once an hour as needed. AV has a diagnosis which impacts cognition. AV was able to communicate pain using nonverbal communication. Staff were directed to look for nonverbal signs that AV was in pain to determine whether an as needed pain medication was indicated. Alleged Perpetrator 2 (AP2) signed out AV's as needed oxycodone thirty-four (34) times in the month of August 2020, as evident by AP2's signature in the narcotics log. Per AV's medication administration record AP2 did not administer AV his/her as needed medication in the month of August 2020. There was not sufficient documentation found to indicate AV was administered his/her as needed pain medication or that AV showed signed to indicate the need for his/her as needed pain medication. Witness interviews do not indicate AP2 administered the medications. AP2's actions are considered financial abuse. The facility failed to protect AV from financial exploitation, which is a violation of Oregon Administrative Rules.