Violation Details: 00170236-AP-135214

Records Request Print
Date
8/10/2021
Report number
00170236-AP-135214
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to properly plan care
Result
Substantiated
Rule(s) Violated
External site: 411-054-0027(1)(f)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
External site: 411-054-0055(a) and (f)
Findings
The facility failed to provide appropriate care, which includes a safe medication administration system and service planning. The Alleged Victim (AV) ran out of pain medication and was not given approximately five (5) doses in August 2021, two (2) doses in September 2021, and fourteen (14) consecutive doses in October 2021, which caused him/her unnecessary discomfort. AV also had five (5) documented falls between August 12, 2021, and October 26, 2021, some resulting in injury. The facility failed to provide a safe medication system and implement interventions to mitigate AV’s increasing fall risk. The failures are a violation of resident rights, are considered neglect of care and constitutes abuse.
Sanction
ALFCP22-00546 $1500.00 fine assessed