Violation Details: 00392157-AP-342751

Date
3/30/2025
Report number
00392157-AP-342751
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to properly plan care
Result
Substantiated
Findings
Alleged Victim (AV) and Witness 1 (W1) relies on the facility for safety and care needs. W1 has a history for resident-to-resident altercations, as W1 is triggered if someone tries to enter W1's personal space and room. AV is serviced plan to use a wheelchair. AV is impulsive at times and forgets to use AV's wheelchair and will be seen ambulating out of AV's room into common areas without wheelchair. On or about March 30, 2025, AV was wondering, and approached W1 sitting at a table with h/h walker. AV touched W1's walker, and W1 swiped at AV causing AV to fall backwards and hit h/h head. AV reported back pain and was transported to the hospital. The facility failed to have person centered interventions in place for AV and W1, resulting in AV and W1 engaging in a resident-to-resident altercation, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
RCFCP25-01052 $375.00 fine assessed