Print Violation: 00169998-AP-134889

Provider Information

Bonaventure of Keizer Memory Care

5525 MCLEOD LANE NE
Keizer, OR 97303

Date: 11/13/2021
Report number: 00169998-AP-134889
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)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
Findings: Alleged Victim (AV) was noted to be a fall risk on or about October 8, 2021, due to multiple diagnoses. However, no changes were made to AV’s care plan after a fall he/she sustained on or about October 8, 2021. On or about November 13, 2021, AV fell out of his/her wheelchair, as a result of the fall, AV sustained a 3 x 4-inch open scrape on his/her forehead, bruising on his/her breast and 2 black eyes. AV also showed signs of pain. The facility failed to properly plan care for AV and mitigate the risk of falls, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction: RCFCP24-00775 $188.00 fine assessed