- Date
- 3/14/2021
- Report number
- 00129695-AP-101190
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to follow care plan
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) was a known fall risk and was care planned to have a tab alarm to alert staff when AV was attempting to ambulate without staff assistance. On or about March 14, 2021, AV was witnessed to attempt to self ambulate and to be removing the tab alarm without it alerting staff. Staff were supposed to complete standby assistance for AV in order to prevent falls due to the failure of the tab alarm. AV attempted to self ambulate and fell, which resulted in a fractured arm. The tab alarm was not in place at the time of the incident, nor were staff present to assist with ambulation. Through the investigated process it was noted that the facility was short staff at the time of the incident. The facility failed to follow the care plan, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP21-02361 $1125.00 fine assessed