Print Violation: 00126027-AP-098082

Provider Information

The Arbor at Avamere Court

450 CLAGGETT COURT N
Keizer, OR 97303

Date: 2/19/2021
Report number: 00126027-AP-098082
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to follow care plan
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
Findings: On or about February 19, 2021, Alleged Victim (AV) fell from a chair in the dining room suffering a laceration to his/her right hand, a dislocated shoulder, and a fracture to his/her humerus. An investigation determined that AV has a history of falls and cognitive deficits and that AV's care plan required the use of a pad alarm in AV's chair to alert staff that AV is moving around or attempting a transfer without assistance. At time of the incident, AV's pad alarm was not in the chair which AV fell from. The facility's failure to follow AV's care plan is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: RCFCP21-02586 $1125.00 fine assessed