Print Violation: 00210616-AP-170259

Provider Information

Skylark Assisted Living

900 SKYLARK PLACE
Ashland, OR 97520

Date: 7/15/2022
Report number: 00210616-AP-170259
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide a safe medication administration system
Result: Substantiated
Rule(s) Violated: External site: 411-054-0025(1)(a) and (b)
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: On or about July 15, 2022, Alleged Perpetrator #3 (AP3) was training the Alleged Perpetrator #2 (AP2) in medication administration. AP2 was in their second day of training and was not yet deemed competent to pass medications alone. AP3 stepped away to assist another resident and AP2 administered another resident’s medications to the Alleged Victim (AV). AP3 failed to ensure the Alleged Victim’s (AV) medications were administered as ordered. The failure resulted in desaturation of AV’s oxygen levels and AV was sent to the hospital for overnight observation. AP3’s actions are a violation of resident rights, is considered neglect of care and constitutes abuse. The facility failed to provide a safe medication administration system, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: ALFCP23-00140 $375.00 fine assessed