Violation Details: 00198333-AP-159246

Date
4/30/2022
Report number
00198333-AP-159246
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide a safe medication administration system
Result
Substantiated
Findings
The facility failed to provide a safe medication administration system to ensure the Alleged Victim’s (AV) pain medication was available to be administered as ordered. He/she went without medication for four consecutive doses resulting in withdrawal symptoms and experiencing unreasonable discomfort. The failure is a violation of resident rights, is considered neglect of care and constitutes abuse. According to documentation, AP2 failed to Order AV'S medication causing AV to go without medication for four consecutive doses resulting in withdrawal symptoms and experiencing unreasonable discomfort. AP2's actions are considered neglect of care and constitutes abuse, which is a violation of Oregon Administrative Rules.
Sanction
ALFCP23-00177 $250.00 fine assessed