Violation Details: 00257026-AP-265350

Date
3/7/2023
Report number
00257026-AP-265350
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to follow care plan
Result
Substantiated
Findings
Alleged Victim (AV) is a high fall risk with a history of prior falls, AV requires full assistance by two staff members with all transfers. On or about March 19, 2023, AV sustained a fall in their room. AV was found on the floor near their recliner. AV stated they had come back from the bathroom and their wheelchair folded up on them. Staff heard a loud bang and responded, finding AV siting on the floor near their recliner. It appears there was no staff present to have help AV transfer from the wheelchair into their recliner. The facility failed to follow AV’s care plan, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction
ALFCP24-00139 $500.00 fine assessed