Violation Details: 00329426-AP-280726

Records Request Print
Date
5/5/2024
Report number
00329426-AP-280726
Type
Abuse: Neglect
Level
3 - Moderate harm or potential for serious harm
Allegation
Failed to provide oversight and monitoring of change of condition
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
External site: 411-054-0040(1)(a) and (d)
Findings
On or about May 5, 2024, the Alleged Victim (AV) suffered an unwitnessed fall, fracturing his/her nose and neck. AV had a change of condition on April 25, 2024, including a urinary tract infection and a leg infection. AV's care plan did not reflect if AV's wheelchair or AV's walker should be within reach of his/her chair. AV's wheelchair was within reach, however, AV's walker was not. The facility's failure to ensure oversight to AV's change of condition and update AV's care plan to reflect proper care is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP24-00797 $375.00 fine assessed