- Date
- 5/15/2023
- Report number
- 00273666-AP-228414
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to provide a safe medication administration system
- Result
- Substantiated
- Findings
- The facility failed to provide a safe medication administration system to ensure The Alleged Victim’s (AV) blood sugar levels were monitored as ordered. Based on facility documentation and interviews, AV's blood sugar was not checked on May 15, 2023 which led to AV falling resulting in a black eye. AV returned to the facility early from a vacation and staff observed AV in the common area on the evening of May 14, 2023. During the evening shift on May 14, 2023, staff did not conduct safety checks, nor offered AV a snack as designated on AV's MAR which resulted in AV blacking out around 5:30am on May 15, 2023, due to his/her blood sugar levels being low. AV was transported to the 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
- RCFCP23-01106 $500.00 fine assessed