- Date
- 4/9/2023
- Report number
- 00256931-AP-212343
- Type
- Abuse: Neglect
- Level
- 4 - Serious harm, death, imminent danger or chronic regulatory noncompliance
- Allegation
- Failed to provide oversight and monitoring of change of condition
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) is diabetic and also has a diagnosis of dementia. On or about February 15, 2023, AV had his/her right great toenail removed by his/her podiatrist. AV was treated with antibiotics and daily wound care and his/her removal of the toenail resolved by March 22, 2023. On or about April 9, 2023, care staff noted that AV's toe had turned black. AV was sent to the hospital and his/her toe was amputated. AV was care planned to have his/her feet checked during showers by staff. There is no documentation that shows that AV's feet were checked by staff at any time, although AV was care planned for this action. The facility's failure to follow AV's care plan and provide oversight and monitoring of AV's condition is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP25-01061 $1500.00 fine assessed