Violation Details: 00319158-AP-271063

Records Request Print
Date
3/15/2024
Report number
00319158-AP-271063
Type
Licensing Violation
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: 411-054-0025(1)(a) and (b)
External site: 411-054-0055(1)(a) and (f)
Findings
On or about March 15, 2024, the facility failed to administer medications to Alleged Victim (AV) as ordered. Based on facility documentation and interviews, AV experienced a medication mix up and ingested another resident's medication when facility staff set another resident's medication next to AV during breakfast and AV mistaken the medication as his/her own. The facility failed to provide a safe medication administration for AV which is a violation of Oregon Administrative Rules. Alleged Perpetrator 2 (AP2) allegedly neglected AV. An investigation determined no abuse occurred.