- Date
- 7/14/2022
- Report number
- 00210513-AP-170178
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to provide a safe medication administration system
- Result
- Substantiated
- Findings
- On or about July 14, 2022, Alleged Perpetrator 2 (AP2) directed Alleged Perpetrator 3 (AP3) to administer previously refused medications to a facility resident. AP3 mistakenly administered the medication to Alleged Victim (AV) instead of the resident the medication was prescribed for, resulting in AV's blood pressure and oxygen levels dropping below normal range and AV was transported to hospital for treatment. Based on interviews and facility documentation, AP3 was not trained to administer medication to residents and was not a Medication Technician; AP2 was responsible for administering medications to residents at the facility. AP2 failed to provide a safe medication administration system to ensure resident medications were administered as ordered. AP2's actions are considered neglect of care and constitutes abuse. The facility failed to provide training, support, and supervision to AP2 and AP3, resulting in harm to AV. The facility's failure to provide a safe medication administration system is a violation of resident rights, is considered neglect of care and constitutes abuse. The allegation that AP3 failed to administer medication as ordered was investigated and findings determined no wrongdoing or abuse occurred by AP3.
- Sanction
- RCFCP22-01623 $500.00 fine assessed