Violation Details: 00359376-AP-309718

Records Request Print
Date
10/9/2024
Report number
00359376-AP-309718
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide inservice
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b), 411-054-0027(1)(g) and (s), 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
Findings
The Alleged Victim (AV) relies on the facility to administer his/her medications. According to an investigation, on or about October 9, 2024, the Alleged Perpetrator 2 (AP2) failed to administer medication as ordered when he/she administered another resident's Gabapentin to AV in error. AV is allergic to Gabapentin. This exposed AV to potential risk of serious harm. AP2's actions are considered neglect and constitutes abuse. The facility failed to ensure medications were administered as ordered, which violates Oregon Administrative Rules.