- Date
- 12/6/2023
- Report number
- 00313135-AP-265522
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) is independent with transfers but needs to call for assistance when weak or unsteady. Between November 2023 and January 2024, AV suffered a fall three times while transferring from his/her wheelchair to the recliner. AV had a rug under his/her recliner that did not lay flat on one corner. On December 6, 2023, staff reported that AV may have suffered a fall due to the rug, however, the facility noted this was a non injury fall. On December 8, 2023, AV had a regularly scheduled doctors appointment, where AV complained on having pain in his/her toe. An x-ray confirmed that AV suffered a fractured toe. The facility's failure to ensure interventions were in place to reduce the risk of falls is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- ALFCP25-00003 $500.00 fine assessed