Violation Details: 00178166-AP-141692

Records Request Print
Date
12/31/2021
Report number
00178166-AP-141692
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to intervene when resident's condition changed
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0040(1)(a) and (d)
Findings
On or about December 31, 2021, the Alleged Victim (AV) was found on the floor in a fetal position after getting up from his/her wheel chair, moving to the glass door and suffering a fall. Staff assisted AV back into his/her wheelchair, but did not notice any injury to AV at the time. AV showed no signs of wanting to walk or get out of his/her wheel chair after the incident. On January 4, 2022, the facility sent AV out for an X-ray, which determined that AV had a fractured pelvis from the fall on December 31, 2021. The facility failed to intervene when AV's condition changed, leaving AV in unreasonable discomfort. The facility's failure is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
RCFCP22-00505 $500.00 fine assessed