- Date
- 7/8/2025
- Report number
- 00412507-AP-363705
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to follow care plan
- Result
- Substantiated
- Findings
- Alleged Victim (AV) and Witness 1 (W1) are residents of a secured memory care facility. Both individuals rely on Alleged Perpetrator 1 (AP1) for their safety and to meet their care needs. AV and W1 have a documented history of a prior resident-to-resident altercation that occurred on or about June 27, 2025, during which AV sustained bruising and increased redness to the left side of the face and nose. Following that incident, specific interventions were implemented to prevent further altercations. These included staff being instructed to redirect AV and W1 away from each other if observed in the same common area and to offer a snack as a distraction.
Despite these interventions, on or about July 8, 2025, AV was seated in a common area when W1 approached and began ramming AV with W1’s walker. As both residents fell to the floor, W1 struck AV in the face, causing a laceration above the eyebrow and bruising to the cheek. AV was transported to the emergency room, where the laceration required medical closure.
AP1 was aware of the prior altercation between AV and W1, and the interventions outlined in the service plan. However, AP1 failed to implement these safety measures, resulting in a preventable resident-to-resident altercation between W1 and AV. AV sustained injuries requiring medical treatment. AP1 failure to follow the established care plan is a violation of resident rights is neglect of care and constitutes abuse.
- Sanction
- RCFCP25-01161 $1125.00 fine assessed