Resident Fall at Walker Methodist Plaza Gardens
According to a report from the Minnesota Department of Health a resident at Walker Methodist Park Gardens was neglected when the facility failed to provide supervision, interventions or education to prevent the resident’s fall that resulted in death.
The Minnesota Department of Health determined neglect was substantiated. The facility was responsible for the maltreatment. The facility had knowledge of the resident’s fall history. The resident’s spouse had diagnoses of dementia, falls and required a Hoyer (mechanical lift) for mobility. The resident’s spouse was unable to provide any type of assistance to the resident. The facility staff would often see family transport the resident from a specialized care area to another area of the facility where significantly less staff supervision was present. The facility failed to provide education or interventions to prevent the resident from being left unsupervised.
MDH Substantiates Neglect Against Walker Methodist Plaza Gardens
The report goes on to state that during interview, licensed staff stated the resident had resided in the facility’s secured memory care unit, however, due to the resident’s history of impulsiveness and falls, the resident was moved to a specialized care area that had a smaller ratio of residents and staff were able to engage more often with the resident. Licensed staff stated unlicensed staff were able to keep a closer eye on the resident and have more hands-on interactions. Licensed staff stated it was not uncommon for the resident’s family to transport her from the specialized care area to another area of the facility for visitations with her spouse and family would return the resident when they left the facility. Licensed staff stated on this day it was between 5:30 p.m. and 5:45 p.m. when family transported the resident out of the specialized care area. Licensed staff stated the resident’s evening services were signed off at 6:20 p.m., when the resident would not have been present in the specialized care area. Licensed staff stated unlicensed staff had not signed off the tasks in real-time making it difficult to know how much time had passed since staff had seen the resident. Licensed staff stated the family typically returned the resident to the specialized care area before leaving the facility, however, on this day the resident was not returned, and staff were unaware family left the facility. Licensed staff stated supervision of the resident was based on scheduled service times and the facility did not provide one to one service. Licensed staff stated the resident would be safe unsupervised for a short period of time, however, not for a long period of time. Licensed staff stated a short period of time would be no longer than the time between scheduled services. Licensed staff stated she was not aware of conversations or communications with the resident’s family about leaving the resident unsupervised and there were no coordinated or written interventions in place between the resident’s family and facility staff.
In conclusion, the Minnesota Department of Health determined neglect was substantiated.
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