Violation Details: 00268932-AP-224015

Records Request Print
Date
6/14/2023
Report number
00268932-AP-224015
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: 411-054-0027(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) medications were administered as ordered. Based on facility documentation and interviews, AV's MAR was missing documented administration of 18 doses of his/her pain management medication, beginning on June 9, 2023 until June 15, 2023, and the associated blank spots on the MAR did not have indicators as the reason for the missed doses. The facility mismanaged AV's medication and AV suffered unreasonable discomfort as a result which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP23-00586 $375.00 fine assessed