Violation Details: 00399192-AP-349909

Records Request Print
Date
4/30/2025
Report number
00399192-AP-349909
Type
Abuse: Neglect
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), 411-054-0070(1)(b) and (5)(a)
Findings
The Alleged Victim (AV) is dependent on the facility to meet his/her safety needs and has a history of falls. According to an investigation, on or about April 30, 2025, AV fell out of their wheelchair. AV's pressure pad alarm was in the wheelchair but was not plugged in and did not function. The Alleged Perpetrator 2 (AP2) did not know the alarm needed to be plugged in when used in the wheelchair. The facility failed to provide in-service and training to a direct care staff, resulting in a fall and unreasonable discomfort to AV, which is a violation of resident rights, is considered neglect of care which constitutes abuse. The allegation that AP2 neglected AV was investigated and determined to be not substantiated.
Sanction
RCFCP25-01029 $250.00 fine assessed