Violation Details: 00374489-AP-324844

Records Request Print
Date
12/18/2024
Report number
00374489-AP-324844
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide a safe medication administration system
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) has severe cognitive deficits and relies on the facility to administer his/her medications. According to an investigation, on or about December 18, 2024, and December 19, 2024, the Alleged Perpetrator 2 (AP2) failed to administer medication as ordered when he/she marked AV's medication administration record (MAR) as the medication "not available" on December 18 and 19, 2024. However, the medication was present at the facility. AP2 had signed that the medications were delivered to the facility prior to the ordered administration times. 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.