Violation Details: 00230518-AP-188469

Date
11/3/2022
Report number
00230518-AP-188469
Type
Licensing Violation
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to follow care plan
Result
Substantiated
Findings
Alleged Victim (AV) relies on the facility for his/her care. AV is care planned to have staff stand behind AV and use a padded gait belt when providing mobility assistance. On or about November 03, 2022, Alleged Perpetrator #2 (AP2) was providing toileting, and transfer care to AV. AP2 did not use a padded gait belt at the time of the transfer. AV fell and sustained a fracture left hip and a laceration to h/h head. AP2 failed to follow the care plan, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to ensure the care plan was being followed, which is a violation of Oregon Administrative Rules.