- Date
- 10/25/2025
- Report number
- 00435285-AP-387170
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to provide a safe medication administration system
- Result
- Substantiated
- Findings
- The facility failed to ensure a safe and reliable medication administration system for the Alleged Victim (AV). Specifically, the facility did not maintain an adequate supply of AV’s prescribed narcotic pain medication, resulting in AV not receiving medications as ordered. Facility documentation and interviews indicate that during a five-day period, AV missed approximately twelve doses of AV’s prescribed narcotic pain medication, which was ordered every four hours. During this time, AV only received AV’s nightly dose of prescribed narcotic pain medication and five doses of PRN non-narcotic pain medication. This failure caused AV unreasonable discomfort and resulted in AV being sent to the emergency room for pain management. The facility’s failure to provide AV’s medication as prescribed is a violation of resident rights, is considered neglect of care which constitutes abuse.
- Sanction
- RCFCP26-00256 $500.00 fine assessed