Violation Details: 00130450-AP-101910

Records Request Print
Date
2/23/2021
Report number
00130450-AP-101910
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide a safe medication administration system
Result
Substantiated
Rule(s) Violated
External site: 411-054-0028(2)(411-054-0055(1)(a) and (f)
Findings
Alleged Victim (AV) relies on the facility to administer his/her medication. On or about February 24, 2021, Alleged Perpetrator 2 (AP2) mistakenly gave AV incorrect doses of medication A and B. Despite being retrained, on March 11, 2021, AP2 made a similar mistake of giving AV the wrong dose of medication A. AP2 failed to provide a safe medication administration system, which is neglect of care and constitutes abuse. The facility failed provide a safe medication administration system, which is a violation of Oregon Administrative Rules.