- Date
- 5/24/2024
- Report number
- 00333232-AP-284339
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to provide safe environment
- Result
- Substantiated
- Findings
- Alleged Victim (AV) has a diagnosis of Alzheimer's disease. Witness #1 (W1) has a diagnosis of unspecified dementia and a history of being the aggressor in altercations during peer-to-peer interactions. AV and W1 have a history of aggression with each other. AV resides in the room where W1 used to live, which causes W1 confusion. There is nothing in AV's or W1's service plan regarding behaviors or negative peer-to-peer interactions. AV and W1 have no instructions to staff about behaviors or escalation in preventative interventions. On or about May 24, 2024, AV and W1 were in a common area with other residents. W1 pulled on a blanket that AV was using, causing AV to pull the blanket back, resulting in AV falling onto the ground. AV obtained a skin tear from the altercation. W1 had five resident-to-resident altercations between March 4, 2024, to May 27, 2024. Neither AV's nor W1's care plan address resident-to-resident altercations, or the issue of these altercations occurring and escalating in frequency for W1. By not having any additional interventions, the facility failed to provide a safe environment and failed to properly plan care, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP24-01273 $500.00 fine assessed