- Date
- 9/23/2025
- Report number
- 00428549-AP-385313
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to provide safe environment
- Result
- Substantiated
- Findings
- Alleged Victim (AV) resides in the Respondent’s facility and depends on facility staff to meet AV’s daily care needs. AV is frequently disoriented and demonstrates poor recent memory. AV and Witness 1 (W1) have a known history of a relationship as well as repeated verbal and physical altercations, including ten documented incidents between June 2025 and September 2025.
As of September 15, 2025, AV’s interim service plan directs facility staff to encourage AV and W1 to spend time apart and requires staff oversight whenever they are together. On September 20, 2025, W1’s interim service plan instructs facility staff to remind W1 that AV has ended their relationship, to check on W1 no less than four times per shift, to encourage W1 to socialize with other individuals, and to ensure W1 does not possess items in W1’s apartment that could be used for self-harm.
On or about September 24, 2025, AV and W1 were in AV’s room with facility staff member (W4) present. During this time, W1 alleged that another staff member intended to rape AV and threatened to physically harm facility staff. W1 then produced a homemade weapon fashioned from a fork and made additional threats toward staff. W4 exited the room, after which W1 barricaded W1 and AV inside AV’s room and locked the door. Law enforcement was contacted to assist in de-escalating the situation. AV required PRN medication for anxiety following the incident.
Respondent failed to ensure a safe environment for AV, which constitutes abuse by neglect.
- Sanction
- RCFCP26-00283 $375.00 fine assessed