Violation Details: 00192704-AP-154115

Date
4/4/2022
Report number
00192704-AP-154115
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide safe environment
Result
Substantiated
Findings
Witness #1 (W1) has a history of aggression towards staff and other residents. On or about April 4, 2022, the Alleged Perpetrator #2 (AP2) saw that W1 was out of bed, however, AP2 assumed that W1 was going back to bed and failed to follow de-escalation protocols put in place for W1. After AP2 walked away from W1, an altercation occurred between W1 and the Alleged Victim (AV), resulting in AV having discoloration to his/her eye and skin tears on his/her hand. AP2 failed to provide a safe environment, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to provide a safe environment, which is a violation of Oregon Administrative Rules.