Violation Details: 00175887-AP-139708

Records Request Print
Date
12/20/2021
Report number
00175887-AP-139708
Type
Abuse: Neglect
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: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(r)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
External site: 411-054-0070(1)(6)(b)(G)
Findings
On or about December 20, 2021, the Alleged Victim (AV) did not receive his/her pain medication as ordered, as the facility medication system showed AV's medications as discontinued, therefore they could not be given. Alleged Perpetrator #2 (AP2) was not trained how to work with "pending" medications in the system, therefore did not know he/she could give the medication. AP2 was further trained to avoid this instance in the future. The facility failed to provide a safe medication administration system, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP22-00589 $250.00 fine assessed