Print Violation: 00261971-AP-217098

Provider Information

Morrow Heights Retirement and Assisted Living Community

176 WARDS CREEK ROAD
Rogue River, OR 97537

Date: 4/15/2023
Report number: 00261971-AP-217098
Type: Licensing Violation
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide a safe medication administration system
Result: Substantiated
Rule(s) Violated: 411-054-0025(1)(a) and (b)
411-054-0027(1)(r)
411-054-0028(2)
411-054-0055(1)(a) and (f)
Findings: The Alleged Victim (AV) was taking two different blood pressure medications, one to be given in the morning and the other in the evening. Facility documentation shows Alleged Perpetrator #2 (AP2) did not follow proper medication administration checks, as AP2 is documented to have given AV the morning blood pressure mediation both morning and evening and not giving the other medication at all from April 15 to April 20. Alleged Perpetrator #3 (AP3) found out about the med errors, however, didn't notify leadership to ensure an investigation was completed and and ensure proper monitoring of affected residents. AP2 and AP3's actions are a violation of resident rights, are considered neglect of care and constitute abuse. The facility's failure to provide a safe medication administration system is a violation of Oregon Administrative Rules.