Violation Details: 00444446-AP-396465

Date
12/9/2025
Report number
00444446-AP-396465
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to properly plan care
Result
Substantiated
Findings
Witness #1 (W1) was known to have inappropriate actions with residents, such as toileting other residents. There were no interventions in place to assure resident safety from W1. On or about December 9, 2025, staff found W1 in the Alleged Victim's (AV) room, taking AV's shirt off, appearing to be assisting AV with a wound. W1 left the room when staff entered. Staff had seen AV and W1 behaving intimately prior to this incident, and were aware that AV did not have the mental capacity to consent to any type of relationship with W1. Respondent failed to ensure interventions were put into place for W1 to ensure the safety of AV. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(ii).
Sanction
ALFCP26-00215 $375.00 fine assessed