Violation Details: 00167477-AP-132833

Date
10/13/2021
Report number
00167477-AP-132833
Type
Licensing Violation
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to follow care plan
Result
Substantiated
Findings
On or about October 13, 2021, the Alleged Victim (AV) was outside smoking and fell into some bushes, sustaining scratches on his/her arms, legs, forehead and the top of his/her head. Alleged Perpetrator #2 (AP2) was supposed to escort and supervise AV while he/she was outside smoking. AP2 returned to the building because it was cold, leaving AV alone outside while he/she watched through a window. At some point, AP2 was distracted by other staff and was not watching AV when he/she fell. AP2's actions placed AV at risk for serious harm, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility's failure is a violation of Oregon Administrative Rules.