Violation Details: 00471097-AP-423529

Records Request Print
Date
4/12/2026
Report number
00471097-AP-423529
Type
Licensing Violation
Level
2 - Minor harm or potential for moderate harm
Allegation
Failed to assist with transfer
Result
Substantiated
Rule(s) Violated
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 for care and services. AV requires the assistance of a caregiver with transfers and ambulation. The Alleged Perpetrator 2 (AP2) was assisting AV to the bathroom and turned and left AV to ambulate independently to get something from AV's closet. AV fell and suffered a fractured arm, which required AV to go to the hospital. The facility failed to provide assistance with transfers which is a violation of Oregon Administrative Rule. AP2 failed to follow the care plan and provide AV with transfer assistance, which is neglect of care and constitutes abuse.