- Date
- 8/8/2024
- Report number
- 00347555-AP-297951
- Type
- Abuse: Neglect
- Level
- 4 - Serious harm, death, imminent danger or chronic regulatory noncompliance
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) is a known fall risk and is diagnosed with a cognition disorder, has inappropriate judgement regarding his/her safety, as well as a wound on his/her foot, which causes the high risk of falls. AV is care planned to be checked on four times per day, AV's door is to be kept open for monitoring and staff are to attempt to take AV to the restroom multiple times per day. AV suffered four unwitnessed falls between July 11, 2024 and August 8, 2024 which resulted in injury. AV had a change of condition and his/her are plan was to be updated with new interventions. No new interventions were added. On or about August 8, 2024, AV suffered an unwitnessed fall, resulting in a fractured hip, requiring surgical intervention. The facility's failure to have interventions in place to assure AV's safety is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP25-00351 $1500.00 fine assessed