- Date
- 11/18/2025
- Report number
- 00440267-AP-392144
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- On or about 11/18/2025, the facility failed to ensure Alleged Victim (AV) received required meal service upon admission. Based on facility documentation and interviews, AV moved into facility on 11/18/2025 and was care-planned to receive meals delivered to his/her room. Facility staff were not informed that AV had arrived or that room tray service was required. As a result, AV did not receive the scheduled dinner meal on 11/18/2025 or the breakfast meal on 11/19/2025. AV reported experiencing hunger. The investigation determined the facility did not enter AV into the facility's internal systems and failed to notify care staff of AV’s presence until the following day. Staff were therefore unaware that AV had moved in, was present in the building overnight, and required room tray delivery beginning on 11/18/2025. This failure to communicate and implement AV’s care plan resulted in unmet nutritional needs which is a violation of resident rights, is considered neglect of care which constitutes abuse.
- Sanction
- ALFCP26-00104 $225.00 fine assessed