Other·March 2, 2022

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 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. During a complaint investigation on 2/10/22, the California Department of Public Health determined the facility failed to ensure one patient was free from a physical restraint when Patient 1's legs were tied together with a plastic trash bag. This failure resulted in restricting the patient's mobility and caused her emotional distress. Review of Patient 1's Minimum Data Set (MDS, an assessment tool), dated 3/11/21, indicated the patient did not have problems with memory and daily decision-making skills, and she had impairment (difficulty moving or using) with one side of her lower extremities (hip, knee, ankle and foot). Review of Patient 1's Situation, Background, Assessment, Recommendation (SBAR, communication tool between health care professionals addressing situation and the planning and rendering of patient care) Alleged Abuse Report of Incident form, dated 3/16/21, indicated on 3/16/21 at 3 a.m., a staff reported Patient 1's legs were tied together by the assigned certified nurse assistant (CNA). Per the CNA on duty, she stated she was keeping the patient from falling since the patient tended to slide her legs out of bed. During an interview on 2/15/22 at 11:32 a.m., the administrator (ADM) stated the staff member was a nursing assistant (NA) and she used a clear plastic waste bag to tie Patient 1's legs together. During an interview on 2/15/22 at 3:10 p.m., Patient 1 stated a staff member "got mad at me" and tied her legs together and she was upset. Patient 1 correctly identified the first name of the NA and stated she tried to have the NA untie her. During an interview on 2/17/22 at 11:32 a.m., the director of nurses stated they were a restraint free facility and staff were not to place patient in restraints. Review of the facility's policy, revised October 2017, indicated patients were to be free from physical restraints that were not required to treat the patients' medical symptoms. This violation had a direct or immediate relationship to the health, safety, or security of the patients