Violation Details: 00244262-AP-200571

Records Request Print
Date
2/8/2022
Report number
00244262-AP-200571
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to provide a safe medication administration system
Result
Substantiated
Rule(s) Violated
External site: 411-054-0027(1)(f)
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 Victim’s (AV) medication(s) were administered as ordered. Based on facility documentation and interviews, AV was prescribed medication to combat edema. Due to medication error by facility, AV was not given his/her medication as ordered which resulted in AV experiencing shortness of breath, chest pain, weight gain, and swelling in both extremities. Due to AV not having his/her medication as ordered, AV experienced side effects and was transferred to hospital for treatment. The facility's failure resulted in unreasonable discomfort, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP23-00309 $1500.00 fine assessed