Print Violation: 00257690-AP-213051

Provider Information

Waterford Grand Assisted Living

600 WATERFORD WAY
Eugene, OR 97401

Date: 4/15/2023
Report number: 00257690-AP-213051
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to follow care plan
Result: Substantiated
Rule(s) Violated: 411-054-0025(1)(a) and (b)
411-054-0027(1)(f) and (r)
411-054-0028(2)
411-054-0036(2)(g)
Findings: The facility and Alleged Perpetrator #2 (AP2) failed to provide appropriate care and services according to Alleged Victim (AV) needs and failed to follow the care plan. AV experiences pain, stiffness and requires extra time when performing ADLs and transferring. AV service plan indicates staff to take AVs complaints of pain seriously, be gentle when touching AV and observe verbal and non-verbal expressions of pain. AV is a one person assist out of bed, allow time to stretch, AV will be stiff at first and will take 10-15 seconds to gain h/h balance. AV may need to get up to use bathroom a couple of times at night. On or about April 15, 2023, AP2 was changing AV in bed and handing AV in a way that caused increased pain in h/h back and legs resulting in unreasonable discomfort AP2’s actions are a violation of resident rights, are considered neglect of care and constitute abuse. The facility failure to ensure adequate supervision and oversight of AV’s care, is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: ALFCP23-00621 $188.00 fine assessed