- Date
- 9/28/2020
- Report number
- 00104408-AP-079620
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to assure resident was safe
- Result
- Substantiated
- Findings
- During the past few years, the facility failed to provide a safe environment and services for the Alleged Victim (AV). On or about September 2020, it was discovered that Alleged Perpetrator 2 (AP2) had not been giving medications on a regular basis to AV, placing AV at risk for serious harm. Alleged Perpetrator 3 (AP3) failed to ensure that AV was safe by not fully completing investigations or reporting to Adult Protective Services (APS) or placing AV on alert for missing medications and having careless disregard for the health and safety of AV. Alleged Perpetrator 4 (AP4) failed to ensure that all information was updated in AV's care plan, leading to AV sustaining falls and injuries of unknown origin. AP4 also failed to report abuse or neglect to APS, placing AV at risk for serious harm. Alleged Perpetrator 5 (AP5) failed to ensure the safety of AV by not having oversight of missed medications, failure to adequately cover nursing responsibilities and failure to notify APS of staffing issues at the facility, placing AV at risk for serious harm. The facility failed to have oversight of all of these items, placing AV at risk for serious harm, which is a violation of resident rights, is considered neglect of care and constitutes abuse.