Violation Details: 00433421-AP-385338

Records Request Print
Date
6/27/2025
Report number
00433421-AP-385338
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to follow care plan
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a)
External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)(a) and (b)
External site: 411-054-0030(1)(a)(A)
External site: 411-054-0036(2)(g)
Findings
Alleged Victim (AV) resides in the Respondent’s facility and depends on facility staff to meet AV’s daily care needs. AV has a documented food allergen. Despite this, AV has been served and has consumed this allergen during meal service on multiple occasions, including a prior incident that resulted in hives. AV’s service plan identifies the food allergen, and the kitchen maintains a whiteboard and reference book containing resident allergen and diet information. On or about June 27, 2025, during meal service, AV was served and consumed a food item to which AV is allergic, resulting in unreasonable discomfort and risk of harm. Respondent failed to follow AV’s service plan and did not take necessary precautions to prevent serving food containing the known allergen. This constitutes abuse by neglect.
Sanction
RCFCP26-00340 $500.00 fine assessed