- Date
- 8/20/2022
- Report number
- 00217133-AP-176175
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to provide a safe medication administration system
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) receives pain medication from the facility. Alleged Perpetrator #2 (AP2) was a medication technician at the facility, trained to dispense medication. In July 2022, AP2 was removed from passing narcotic medications due to suspicion of taking narcotics from a resident. On or about August 7, 2022, AP2 was allowed again to dispense narcotic medication again, and within a few days, AV's narcotic medication was a different color, appearing to have been diluted. AV soon reported increased weakness and dizziness, was shaky and increased pain. On or about August 18, 2022, the facility was made aware of the discrepancy of the diluted medication, however, AP2 was not removed from passing medications and the evaluation of the medication was not completed until two days later, and the narcotic was found to be clear in color. AP2 was then pulled from passing medications and AV started to feel much better. Further testing of the medication declared that the medication was diluted to 25% strength. AP2's actions are a violation of residents rights, are considered neglect of care and constitute abuse. The facility's failure is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- ALFCP23-00680 $375.00 fine assessed