Violation Details: 00424893-AP-376460

Records Request Print
Date
9/5/2025
Report number
00424893-AP-376460
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to provide service
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) relied on the facility for care, had poor vision and depth perception, and was known to have declining memory. AV was service planned to require full assistance with reminders, redirection, and escorts. On or about September 5, 2025, AV was found on the floor between two chairs. AV was observed to be in pain with a large lump on AV's head and was sent to the hospital. According to an investigation staff observed AV pacing the hallways before AV was found on the floor and it was believed AV was attempting to sit down where there was no chair. The facility failed to provide appropriate services according to AV’s needs, regarding care planning, safety checks and monitoring, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction
RCFCP26-00540 $375.00 fine assessed