Print Violation: 00186132-AP-159570

Provider Information

Bonaventure of Albany Assisted Living

420 GERI ST NW
Albany, OR 97321

Date: 2/25/2022
Report number: 00186132-AP-159570
Type: Abuse: Neglect
Level: 3 - Moderate harm or potential for serious harm
Allegation: Failed to provide a safe medication administration system
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
Findings: Alleged Victim's (AV's) care plan states that if he/she misses antipsychotic medication, AV will have a psychotic episode. AV’s antipsychotic medication was not administered between February 12th through February 25, 2022. On or about February 24, 2022, AV complained of insomnia, went to the emergency department, and was prescribed medication to help him/her sleep. Once back at the facility, AV asked for the sleep medication but was told it would not be administered. As a result, AV started to yell and became upset. AV then eloped the facility and returned to a home he/she owns. Alleged Perpetrator 2 (AP2) was responsible to establish a medication administration program, monitor all medications and prescriptions, update the medication system as needed, to daily review all medication orders to follow up on any prior authorizations, and to document in the resident process notes. AP2 and the facility failed to provide a safe medication administration system for AV, which is a violation of resident rights, is neglect of care and constitutes abuse.
Sanction: ALFCP23-00085 $2000.00 fine assessed