- Date
- 8/17/2025
- Report number
- 00421995-AP-373474
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- Alleged Victim (AV) relies on the facility for his/her care. On or about August 17, 2025, at around 7:20 PM, AV fell while walking laps. AV had three (3) prior falls in the past 90 days. On or about August 5, 2025, physical therapy identified AV as a high fall risk and AV was to have supervision at all times. AV was not being supervised when walking laps and was found on the ground. Respondent failed to update AV's service plan noting AV is at a high risk for falls and should have supervision at all times, and to ensure the safety of AV. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(i).
- Sanction
- RCFCP26-00429 $500.00 fine assessed