Violation Details: 00345139-AP-295600

Date
7/29/2024
Report number
00345139-AP-295600
Type
Abuse: Neglect
Level
4 - Serious harm, death, imminent danger or chronic regulatory noncompliance
Allegation
Failed to answer call light in a timely manner
Result
Substantiated
Findings
The Alleged Victim (AV) was known to choke on food. On or about June 4, 2024, AV had a choking incident while eating in his/her room. AV's family member happened to be with AV and cleared AV's airway. AV's service plan requests staff to encourage AV to eat in the dining area and AV's food was to be cut up. On or about July 29, 2024, AV pressed his/her call light for staff assistance. Two staff were working that day. One staff member thought the other was assisting with call lights, however, the other staff was sick and was in the bathroom at the time the call light was pressed. AV was found in his/her room unresponsive 15 minutes later when staff checked. EMS was called and were unsuccessful at resuscitating AV. The facility's failure to ensure there were enough staff to ensure a safe environment for the resident is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
ALFCP25-00009 $2500.00 fine assessed