Violation Details: 00447063-AP-399721

Records Request Print
Date
11/17/2025
Report number
00447063-AP-399721
Type
Abuse: Neglect
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to properly plan care
Result
Substantiated
Rule(s) Violated
411-054-0025(1)(a) and (b)
411-054-0027(1)(g) and (s)
411-054-0028(2)
411-054-0036(2)(g)
Findings
On or about November 17, 2025, the Alleged Victim (AV) suffered a fall while being assisted to the bathroom by Alleged Perpetrator #2 (AP2). AV consistently resists assistance and staff are to rely on verbal communication between each other for resident supports, as resident care plans are not up to date. AV's care plan directs staff to gently bring AV into the restroom, however, it does not provide direction to staff on how they are to provide hands on assistance. AP2's actions were found to be unsubstantiated in this case. Respondent failed to ensure resident care plans were up to date and provided enough information to ensure staff understood how to work with residents. This constitutes abuse by neglect, as outlined in OAR 411-020-0002(1)(b)(A)(i).
Sanction
RCFCP26-00306 $250.00 fine assessed