Violation Details: 00330935-AP-282212

Date
5/12/2024
Report number
00330935-AP-282212
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to follow care plan
Result
Substantiated
Findings
Alleged Victim (AV) is care planned to be on a pureed diet only. On or about May 12, 2024, Alleged Perpetrator 2 (AP2) gave Jello to AV which contained fruit chunks to AV. As a result, AV began to choke on a piece of fruit and was given the Heimlich to expel the chunk of fruit he/she was choking on. AP2 failed to follow the care plan around AV’s pureed diet, which is neglect of care and constitutes abuse. The facility failed to assure AV’s care plan was being followed, which is a violation of Oregon Administrative Rules.