Violation Details: 00157279-AP-124719

Date
8/20/2021
Report number
00157279-AP-124719
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to properly plan care
Result
Substantiated
Findings
On or about August 20, 2021, Alleged Victim (AV) was found by facility staff on the floor of his/her bedroom. It was determined by facility staff that AV fell from his/her bed; however, AV did not express pain a the time of fall. AV later reported to facility staff that he/she was suffering from pain two days after the incident in which AV was then transported to the hospital for treatment and was diagnosed with a fracture to his/her spine. An investigation determined that facility failed to implement interventions into AV's care plan to ensure AV's bed rail was properly raised when AV had increased alcohol consumption. The facility's failure is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP22-00252 $375.00 fine assessed