Aging and People with Disabilities
Safety, Oversight and Quality
Print Violation: 00350581-AP-306023
Provider Information
Klamath Falls Senior Living
2130 N ELDORADO AVE
Klamath Falls, OR 97601
- Provider ID
- 70M024
- Administrator
- Eileen McCoy
- Phone
- (541) 882-4830
- ed.klamathfalls@klamathfallsseniorliving.com
Violation Details
- Date
- 8/26/2024
- Report number
- 00350581-AP-306023
- Type
- Abuse: Neglect
- Level
- 3 - Moderate harm or potential for serious harm
- Allegation
- Failed to provide service
- Result
- Substantiated
- Rule(s) Violated
-
External site: 411-054-0025(1)(a) and (b), 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0036(2)(g)
- Findings
- The Alleged Victim (AV) relies on the facility for his/her care. The AV is a known fall risk with a history of falls and is known to try and be independent even when he/she is care planned as an assist. AV was care planned to be checked on four times per shift and to be reminded to ask for assistance with transfers when feeling week. According to investigation, on or about August 25, 2024, AV was placed on an interim service plan to help AV with transfers and escorts. On or about August 26, 2024, AV experienced a non-injury fall while trying to use an assisted device by him/herself. On or about September 1, 2024, AV experienced a fall that resulted in a head injury, requiring stiches to repair. AV also had two skin tears to his/her elbow. It was determined that AV pressed his/her pendant for assistance prior to the fall. Staff interviewed indicated there was no consistent checks on AV and/or understanding of AV’s care plan. According to medical records, the stitches on AV’s head were supposed to be in for five to seven days but were still in AV’s head after forty-four days of the incident. The facility failed to provide appropriate services, related to care planning, lack of interventions, and following AV’s care plan, which is a violation of resident rights, is neglect of care which constitutes abuse.
- Sanction
- ALFCP25-00035 $1500.00 fine assessed