Print Violation: 00372458-AP-322841

Provider Information

Klamath Falls Senior Living

2130 N ELDORADO AVE
Klamath Falls, OR 97601

Date: 12/17/2024
Report number: 00372458-AP-322841
Type: Abuse: Neglect
Level: 2 - Minor harm or potential for moderate harm
Allegation: Failed to provide service
Result: Substantiated
Rule(s) Violated: External site: 411-054-0025(1)(a) and (b)
External site: 411-054-0027(1)(g) and (s)
External site: 411-054-0028(2)
External site: 411-054-0030(1)(e)(I)
External site: 411-054-0036(2)(g)
Findings: The Alleged Victim (AV) relied on the facility for care and was service planned to be checked on two times per shift and for their briefs to be changed two times while asleep, to prevent soiled bedding. AV had a history of UTIs. On or about December 17, 2024, AV was found lying in bed, soaked in urine. Facility staff was not sure when the last time AV was checked on, and AV stated they had been needing help for 4 hours. According to an investigation, AV's room smelled strongly of urine. Document review revealed AV refused care often but there were no interventions put in place regarding refusal behaviors. The facility failed to provide appropriate services, to include following the care plan and/or implementation of effective interventions, and resident monitoring, placing AV at risk for recurring UTIs and skin breakdown, which is a violation of resident rights, is considered neglect of care and constitutes abuse.
Sanction: ALFCP26-00204 $500.00 fine assessed