Violation Details: 00455815-AP-408013

Records Request Print
Date
2/5/2026
Report number
00455815-AP-408013
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to follow care plan
Result
Substantiated
Rule(s) Violated
External site: 411-054-0025(1)(a) and (b), 411-054-0027(1)(g) and (s), 411-054-0028(2)
Findings
The Alleged Victim (AV) relies on the facility to provide care and services. AV's care plan requires that two caregivers provide assistance with all transfers. According to an investigation, Alleged Perpetrator 2 (AP2) transferred AV without the assistance of another caregiver, which caused AV to suffer unreasonable discomfort. The failure is a violation of Oregon Administrative Rules. AP2's actions are a violation of resident rights, considered neglect and constitutes abuse.