- Date
- 10/20/2025
- Report number
- 00434112-AP-385985
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- On January 27, 2026, ODHS Adult Protective Services (APS) completed investigation #00434112 and issued a written investigation report, which is incorporated here by reference. The Alleged Victim (AV) resided at the Respondent’s facility. The facility failed to implement and consistently follow progressive, appropriate, and effective fall-prevention interventions to mitigate AV’s known fall risk. On or about October 20, 2025, AV sustained abrasions to both knees after falling in the bathroom. Based on facility documentation and interviews, AV had a significant fall history prior to incident, experiencing more than 20 falls since May 2025, several of which resulted in injuries. These repeated failures to provide adequate supervision and interventions caused multiple unwitnessed falls, unreasonable discomfort, which is a violation of resident rights., is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP26-00156 $1125.00 fine assessed