- Date
- 4/10/2025
- Report number
- 00394877-AP-345801
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) lives in a secured memory care facility and depends on staff (AP1) to help with daily care, safety, and supervision. AV has a history of falling and is at high risk due to cognitive impairment, poor balance, weakness, not using a walker, and taking medications that affect stability. AV also doesn’t use the call light for help and has a condition that increases the risk of falling. On April 10, 2025, AV was found on the floor with a bleeding head wound. It was unclear how long AV had been on the floor prior to being discovered. AV sustained a head injury and required transport to the hospital for medical evaluation and treatment. The facility failed to adequately care plan for AV’s known fall risks and did not implement reasonable, person-centered interventions to mitigate future falls, which is violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP25-01162 $375.00 fine assessed