Print Violation: 00136595-AP-107333

Provider Information

Guardian Angel Homes Memory Care

540 NW 12TH ST
Hermiston, OR 97838

Date: 4/21/2021
Report number: 00136595-AP-107333
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to properly plan care
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)
External site: 411-054-0040(1)(a) and (d)
Findings: On or about April 21, 2021, Alleged Victim (AV) suffered an unwitnessed fall in his/her bedroom. An investigation determined that facility staff failed to care plan for the potential of increased falls by AV as directed by PCP due to a medication dosage change. PCP advised staff that AV's recent medication dosage change would likely lead to an increase in falls while getting the correct dosage. The facility's failure to properly care plan for AV's potential fall risk is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: RCFCP21-03181 $1125.00 fine assessed