Print Violation: 00257280-AP-212688

Provider Information

Trustwell Living at River Run Place

1155 DARLENE LANE
Eugene, OR 97401

Date: 4/9/2023
Report number: 00257280-AP-212688
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to protect resident from financial exploitation
Result: Substantiated
Rule(s) Violated: External site: 411-054-0027(1)(f) and (r)
External site: 411-054-0028(2)
Findings: Alleged Victim (AV) relies on the facility to administer his/her medication. In March 2023, it was noticed that a narcotic was missing and was termed a “med error”, by the facility and no investigation, inquires, or referrals were made. On or about April 9, 2023, at around 8pm, Alleged Perpetrator 2 (AP2) signed out one morphine pill, leaving account of 22. On April 9, 2023, there was another morphine pill popped, but no med tech signature and no time written on the form. The next entry on April 10, 2023, was by Witness 3 (W3) at 8am, leaving a count of 20. AP2 worked the swing shift and the NOC shift and was the med tech on duty for both shifts. AP2 had the only set of med cart keys during the shift and did not give them to anyone else. AP2 did not have any explanation as to how the narcotic went missing on two different occasions. AP2 failed to fail to protect AV from financial exploitation, which is neglect of care and constitutes abuse. The facility failed to protect AV from financial exploitation, which is a violation of Oregon Administrative Rules.