- Date
- 5/6/2022
- Report number
- 00198536-AP-159473
- Type
- Licensing Violation
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to follow care plan
- Result
- Substantiated
- Findings
- The Alleged Perpetrator 2 (AP2) failed to follow the Alleged Victim's (AV) care plan to ensure a fall mat was in place when AV was in bed. The failure resulted in AV falling from his/her bed onto the floor causing unreasonable discomfort, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to ensure AV's care plan was followed, which is a violation of Oregon Administrative Rules.