- Date
- 4/12/2022
- Report number
- 00195496-AP-156684
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- Alleged Victim (AV) has a known history of falls. On or about April 12, 2022, AV sustained a fall which resulted in AV getting stuck between his/her bed side rail and mattress and caused AV a fracture L2 vertebrate. AV had sustained a previous fall earlier in the day and a fall on April 9, 2022, and a prior fall in December 2021 which resulted in a broken neck to AV. During all prior falls, the facility had not documented new interventions to prevent future falls. The facility failed to care plan appropriately and implement interventions to mitigate AV’s risk of falls, which is a violation of resident rights, is neglect of care and constitutes abuse.
- Sanction
- ALFCP22-01023 $1500.00 fine assessed