Violation Details: 00399848-AP-350633

Records Request Print Provider Details
Date
5/5/2025
Report number
00399848-AP-350633
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to follow care plan
Result
Substantiated
Rule(s) Violated
411-054-0025(1)(a) and (b)
411-054-0027(1)(g) and (s)
411-054-0028(2)
411-054-0036(2)(g)
Findings
On or about May 5, 2025, the Alleged Victim (AV) was found with a .4 cm sore on his/her buttocks. AV was care planned to be changed every two hours and were supposed to place a pressure reducing cushion under AV to alleviate pressure on the area. Staff did not follow AV's care plan as AV was found multiple times caked in bowel and urine. Respondent failed to ensure staff followed the care plan. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(i).
Sanction
RCFCP26-00017 $375.00 fine assessed