Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: 00316598-AP-268719
Provider Information
Churchill Estates Assisted Living
1919 BAILEY HILL RD
Eugene, OR 97405
- Provider ID
- 70M014
- Administrator
- Deborah Hankins
- Phone
- (541) 485-8320
- d.hankins@churchillretirement.com
Violation Details
- Date
- 3/3/2024
- Report number
- 00316598-AP-268719
- 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)
External site: 411-054-0028(2)
External site: 411-054-0055(1)(a) and (f)
- Findings
- On March 3, 2024, Alleged Perpetrator 2 (AP2) failed to administer Alleged Victim's (AV) narcotic medication as ordered. On March 3, 2024, during the 8pm medication pass, AP2 "popped" from AV's morning bubble card instead of "popping" from AV's evening bubble card. Based on facility documentation and interviews, AP2 did not follow protocol while passing AV's evening medication. AP2 failed to ensure he/she was matching the medication with the EMAR and failed to administer one narcotic tablet as the MAR reads but instead administered two narcotic tablets. AP2 also failed to get a second check from another medication technician to verify the correct dose was being administered prior to AP2 administering AV's narcotic medication. AP2's training checklist for Controlled Medication Tracking was initialed by AP2. AV experienced a headache resulting in unreasonable discomfort due to AP2's failure to administer his/her narcotic medication as ordered. AP2's actions is considered neglect of care which constitutes abuse. The facility is responsible for the supervision, training, and overall conduct of staff when staff are acting within the scope of his or her employment duties. Facility's failure to provide a safe medication system caused AV unreasonable discomfort which is a violation of resident rights, is considered neglect of care, and constitutes abuse.
- Sanction
- ALFCP24-00189 $338.00 fine assessed