Violation Details: 00209288-AP-169135

Records Request Print
Date
6/22/2022
Report number
00209288-AP-169135
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to provide oversight and monitoring of change of condition
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)l 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0040(1)(b) and (c)
External site: 411-054-0040(2)(a)
Findings
Initial: According to witnesses and documentation, the Alleged Perpetrator 2 (AP2) failed to adequately monitor, assess, and document AV's skin condition, which resulted in AV not receiving timely medical treatment. AV experienced pain and discomfort and on or about July 22, 2022, the AV was sent to the hospital where AV passed away a few days later. AP2 did not follow proper procedure for wound care. AP2's actions are considered neglect and constitutes abuse. The facility allegedly failed to provide oversight and monitoring of change of condition, which is a violation of resident rights, is considered neglect of care and constitutes abuse. Amended: Removed language is shown as [bracketed]. According to witnesses and documentation, the Alleged Perpetrator 2 (AP2) failed to adequately monitor, assess, and document AV's skin condition, which resulted in AV not receiving timely medical treatment. [AV experienced pain and discomfort and on or about July 22, 2022, the AV was sent to the hospital where AV passed away a few days later] AV was sent for medical treatment on June 22, 2022. AP2 did not follow proper procedure for wound care. AP2's actions are considered neglect and constitutes abuse. The facility allegedly failed to provide oversight and monitoring of change of condition, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
RCFCP23-00894 $1500.00 fine assessed