- Date
- 4/8/2026
- Report number
- 00468856-AP-421173
- Type
- Abuse: Neglect
- Level
- 2 - Minor harm or potential for moderate harm
- Allegation
- Failed to provide safe environment
- Result
- Substantiated
- Findings
- Alleged Victim (AV) and Witness 1 (W1) reside in the Respondent’s facility and depend on facility staff for their safety and daily care. W1 has a documented history of altercations with other residents, including two incidents in March 2026 and one incident in April 2026. W1 is service-planned to receive as-needed medication for agitation; however, the facility failed to develop adequate interventions to address W1’s behavioral history, and staff left residents without appropriate supervision or oversight.
On or about April 8, 2026, W1 was observed wandering the unit. AV was seated in a dining chair across the room when W1 approached. After a verbal exchange between AV and W1, a physical altercation occurred during which W1 struck AV. The Respondent failed to ensure a safe environment and did not develop or implement appropriate interventions to mitigate known risks. This constitutes abuse by neglect as defined in OAR 411-020-0002(1)(b)(A)(i).
- Sanction
- RCFCP26-00606 $375.00 fine assessed