- Date
- 1/17/2024
- Report number
- 00318080-AP-270074
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) is a known fall risk and had a history of falls prior to moving into the facility. AV suffered a fall in November 2023. After this fall, a new intervention was put into place to remind AV to use his/her call light for assistance. AV suffered three more falls in late November and mid-December 2023, no new interventions were implemented. On December 18, 2023, AV was found on the floor in a pool of blood, it was believed that AV's blood sugar medication may have caused dizziness, leading to the facility to implement ensuring that AV eats before taking the medication. In January 2024, AV suffered three more falls without any interventions put into place. Respondent failed to ensure new and meaningful interventions were put into place to reduce the risk of falls. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(i).
- Sanction
- ALFCP26-00045 $500.00 fine assessed