- Date
- 1/20/2024
- Report number
- 00325575-AP-277318
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- Alleged Victim (AV) service plan indicates AV is independent in ambulation, has problems with peripheral vision and has history of falls. On or about January 20, 2024 AV had experienced two falls resulting in abrasions. The first fall, AV was noted to be jogging through hallways. AV got caught up in the power cord and tripped over it falling onto right side. Contributing Factors noted balance, the need for occasional physical support and gait disturbance. The second fall, AV was wandering around the facility. AV got off balance and fell. Contributing Factors noted gait disturbance. No person centered interventions were updated in AV service plan from prior falls which resulted in AV having two falls on January 20, 2024. The facility failed to appropriately care plan and implement reasonable interventions to address AV’s increasing and ongoing falls, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP24-00825 $500.00 fine assessed