Violation Details: 00295371-AP-249060

Records Request Print
Date
10/30/2023
Report number
00295371-AP-249060
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to follow care plan
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0036(2)(g)
Findings
The Alleged Perpetrator 2 failed to follow the Alleged Victim's care plan to ensure his/her pressure pad alarm was on and working while in bed, for fall safety. The failure resulted in AV attempting to get up on his/her own, causing a fall with injury, which is a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to ensure AV's care plan was followed which is a violation of Oregon Administrative Rules.