- Date
- 11/22/2025
- Report number
- 00441108-AP-393018
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to properly plan care
- Result
- Substantiated
- Findings
- The facility failed to implement effective interventions and provide appropriate supervision despite the Alleged Victim’s (AV) known history of falls. AV experienced multiple falls over a two-day period, including one fall on November 21, 2025, and two additional falls on November 22, 2025. During one of these incidents, AV sustained a bump to the left side of the forehead after striking the ground. The lack of appropriate oversight and failure to implement necessary fall-prevention measures resulted in avoidable injury and unreasonable discomfort to AV. The facility's failure to properly care plan for AV's fall risk is a violation of resident rights, is considered neglect of care and constitutes abuse.
- Sanction
- RCFCP26-00360 $375.00 fine assessed