- Date
- 2/18/2025
- Report number
- 00384258-AP-334760
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The facility failed to implement appropriate interventions and provide adequate supervision related to the Alleged Victim’s (AV) known history of falls. On or about February 15, 2025, AV experienced an unwitnessed fall in AV's room and suffered a skin tear to AV's right elbow. Based on facility documentation and interviews, AV suffered a fall the day prior, that caused multiple injuries to AV. It was determined AV was experiencing a significant change of condition and had a decreased in mobility; however, no further interventions for falls were implemented for AV at that time. The facility 's failure to provide the basic care and services necessary to maintain the health and safety of AV, caused AV to experience a fall with injury causing AV unreasonable discomfort which is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP25-00648 $1125.00 fine assessed