- Date
- 7/16/2025
- Report number
- 00414459-AP-365707
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The Alleged Victim (AV) has suffered prior falls while ambulating. AV uses a wheelchair for ambulation; however, AV's care plan wasn't updated to advise staff of safety measures while assisting AV in his/her wheelchair. On or about July 16, 2025, staff were pushing AV in his/her wheelchair. AV did not have footrests on his/her wheelchair, resulting in AV putting his/her feet on the ground, causing AV to fall from the wheelchair to the floor, causing AV to have a skin tear to his/her nose. AV was sent to the hospital and diagnosed with a fractured nose, as well as receiving stitches to his/her nose. The respondent's failure to properly care plan, to ensure staff were ensuring AV had footrests on his/her wheelchair for safety. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(i).
- Sanction
- RCFCP26-00072 $1125.00 fine assessed