Violation Details: 00424080-AP-377254

Records Request Print Provider Details
Date
8/31/2025
Report number
00424080-AP-377254
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to properly plan care
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
The Alleged Victim (AV) has a history of pressure sores. On or about August 31, 2025, AV was found to have a pressure sore on his/her buttocks with blood present in his/her brief. On or about September 2, 2025, AV had a stage 2 wound on his/her buttocks. On or about September 11, 2025, AV's wound was larger. No new interventions were put into place to reduce the risk of further wound worsening. Respondent failed to ensure interventions were put into place to decrease the worsening of AV wound, or to ensure AV would not have new wounds. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(i).
Sanction
RCFCP26-00052 $1000.00 fine assessed