Violation Details: 00145975-AP-115325

Records Request Print
Date
6/21/2021
Report number
00145975-AP-115325
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to provide oversight and monitoring of change of condition
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(r)
External site: 411-054-0028(2)
External site: 411-054-0040(1)(a) and (d)
External site: 411-054-0055(1)(a) and (f)
Findings
On or about June 21, 2021, the Alleged Victim (AV) suffered from low blood glucose count. Facility staff did not report AV's low CBG to his/her physician or hospice, rather they gave AV juice to try to counteract AV's low CBG. On June 22, 2021, AV was unresponsive, rather than sending AV to the emergency room, staff waiting for hospice staff to advise instruction. AVs family instructed the facility to send AV to the emergency room. Had the facility contacted hospice or AV's physician on June 21, 2022, the second episode may have been able to be prevented. The facility failure to is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP22-01071 $500.00 fine assessed