Violation Details: 00233893-AP-191478

Records Request Print
Date
11/22/2022
Report number
00233893-AP-191478
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide a safe medication administration system
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and f)
Findings
The facility failed to provide a safe medication administration system to ensure the Alleged Victims (AV) medication orders were administered as prescribed. AVs pain medication orders were changed on or about November 22, 2022, with instructions to administer four doses of pain medication to AV per day. Documentation provided indicates the facility did not give the AV the prescribed amount of pain medication from approximately November 22, 2022, through November 28, 2022, resulting in AV experiencing “terrible” amount of pain in h/h shoulder. The facility’s failure is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP23-00258 $500.00 fine assessed