Print Violation: 00059540-AP-042362

Provider Information

Cedar Village Assisted Living Community

4452 LANCASTER DR NE
Salem, OR 97305

Date: 11/21/2019
Report number: 00059540-AP-042362
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to provide or maintain resident care equipment
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0030(1)(e)(I)
External site: 411-054-0036(2)(g)
Findings: On or about November 21, 2019, the Alleged Victim (AV) fell in his/her room causing a compression fracture to his her spine. AV's walker brakes were not working and the walker shot out from in front of AV causing the fall. The facility was aware that AV's walker was not in good working condition and failed to maintain the AV's care equipment. AV was known to be shaky and unsteady during ambulation and was to call for assistance if feeling shaky, however, AV was also known to fall during ambulation and transfers, and was declining, however, appropriate interventions were not put in place to prevent the falls. The facility failed to follow maintain resident care equipment and have appropriate interventions regarding AV's risk of falls. The facility's failure is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: ALFCP20-00006 $375.00 fine assessed