The Winston-Salem Journal reported the $20,000 fine given to Bradford Village of Kernersville, N.C. for failing to keep a blind resident safe.  The poor woman wandered away from the facility unsupervised and drowned in a puddle about 200 feet away.

The report found that the resident had approached staff in the front lobby three times between 11 p.m. and 12:30 a.m., each time in a confused, disoriented state. She asked someone to take her across the creek to the next county. Staff said they took the resident back to her bed each time, and she was in her bed at the 2 a.m. check.

The woman somehow left the facility between 2 and 4 a.m. on Nov. 12, 2009, through a door with the alarm turned off.  Employees told state investigators that the alarms were often turned off to allow workers to take smoking breaks, and the third-shift supervisor was unaware the alarm needed to be activated at 9 p.m.  The resdient was reported missing at 4:15 a.m., and a family member finally found her lying face down in water about 2 inches deep.

The home was found in violation of three codes regarding physical environment, personal care and supervision, and resident rights. The agency said the home "failed to ensure measures were utilized to prevent residents assessed as being disoriented and having wandering behaviors from exiting the facility building unsupervised."


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