Other·May 11, 2021

F604, §483.10(e)(1); §483.12(a)(2) Right to be Free from Physical Restraints §483.10(e) Respect and Dignity. The resident has a right to be treated with respect and dignity, including: §483.10(e)(1) The right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience, and not required to treat the resident's medical symptoms, consistent with §483.12(a)(2). §483.12(a)(2) The resident has the right to be free from abuse, neglect, misappropriation of resident property, and exploitation as defined in this subpart. This includes but is not limited to freedom from corporal punishment, involuntary seclusion and any physical or chemical restraint not required to treat the resident's medical symptoms. §483.12(a) The facility must- §483.12(a)(2) Ensure that the resident is free from physical or chemical restraints imposed for purposes of discipline or convenience and that are not required to treat the resident's medical symptoms. When the use of restraints is indicated, the facility must use the least restrictive alternative for the least amount of time and document ongoing re-evaluation of the need for restraints., On 4/19/21, an unannounced visit was conducted at the facility to investigate an entity reported incident regarding Quality of Care/Treatment. The facility failed to ensure Resident 140 was free from physical restraints when staff placed both of Resident 140's feet into a single pressure relief boot (device strapped to the foot in order to reduce pressure on the heels). This practice impaired Resident 140's ability to move both lower extremities (feet and legs) and had the potential to negatively affect his physical and psychosocial well-being. Review of Resident 140's clinical record indicated he was admitted on 11/4/2019 and had the diagnoses of respiratory failure (the body is unable to effectively transfer oxygen and carbon dioxide) and myoclonus (muscle jerks). Review of Resident 140's Minimum Data Set (MDS, an assessment tool), dated 1/6/21, indicated he was totally dependent (staff provide full assistance) and required physical assistance from two or more people for bed mobility (how the resident moves to and from lying position, turns side to side, and positions body while in bed). Review of Resident 140's Interdisciplinary Team (IDT, staff from different disciplines who work together to plan and provide care) Progress Notes, dated 2/8/21, indicated Resident 140 was on a video call with his family member on "Saturday afternoon" (2/6/21 based off the date of the IDT Progress Notes). The notes indicated Resident 140's family member asked to see the resident's body head to toe and "noticed that he only had one booty on for both feet and called the attention of the charge nurse on duty." The notes further indicated the restorative nursing assistant (RNA) "assisted the charge nurse in unstrapping the pressure relief booty and repositioning the resident." Review of Resident 140's undated Event Summary indicated the facility conducted an investigation of the above incident. The Event Summary indicated certified nursing assistant HH (CNA HH) "openly discussed that it was her that took care of [Resident 140] and placed both his feet in a single booty." According to the Event Summary, CNA HH did this because Resident 140 kept repositioning his legs and swinging them off the bed. The Event Summary indicated the administrator (ADM) explained to CNA HH that "this was not an appropriate practice and that devices should never be used in such a manner." The Event Summary further indicated this practice resulted in "unintentionally restraining the resident's feet to a single booty." During an observation on 4/21/21 at 12:10 p.m., Resident 140 was lying in bed with his feet spread apart. Both feet were hanging slightly over the edges on either side of the bed, but Resident 140 did not appear to be in danger or distress. He was wearing one pressure relief boot on each foot. During an interview with restorative nursing assistant II (RNA II) on 4/23/2021 at 11:48 a.m., he confirmed Resident 140 was able to move his lower extremities without staff assistance. During an interview with the ADM on 4/23/21 at 12:10 p.m., he confirmed CNA HH applied a restraint to Resident 140 when she placed both his feet in a single pressure relief boot. The ADM acknowledged this was a restraint because it impaired Resident 140's ability to move his lower extremities. The ADM stated this was not a correct practice. During an interview with registered nurse E (RN E) on 4/23/21 at 12:29 p.m., she stated CNA HH admitted that she placed both of Resident 140's feet in a single pressure relief boot. RN E confirmed Resident 140 did not have a physician's order for physical restraints, nor was it part of the resident's plan of care. RN E also confirmed the facility did not have consent to restrain Resident 140. Review of the facility's policy titled "Use of Restraints," revised 12/2008 indicated, "Physical Restraints are defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the resident's body that the individual cannot remove easily, which restricts freedom of movement or restricts normal access to one's body. Practices that inappropriately utilize equipment to prevent resident mobility are considered restraints and are not permitted." The policy further indicated, "Restraints shall only be used upon the written order of a physician and after obtaining consent from the resident and/or representative (sponsor)." In violation of the above cited standards, the facility failed to ensure Resident 140 was free from physical restraints when staff placed both of Resident 140's feet into a single pressure relief boot. This practice impaired Resident 140's ability to move both lower extremities and had the potential to negatively affect his physical and psychosocial well-being. The above violation caused or occurred under circumstances likely to cause significant humiliation, indignity, anxiety, or other emotional trauma to the resident.