Other·November 5, 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. The facility failed to ensure Resident 3 was free from physical restraint when licensed vocational nurse A (LVN A) wrapped a sheet around Resident 3's waist while sitting on his wheelchair. This failure had the potential to impact the physical and mental well-being of Resident 3. Review of Resident 3's clinical record, indicated Resident 3 had diagnoses of alcohol dependence with withdrawal delirium (severe alcohol withdrawal symptoms such as shaking, confusion, hallucinations), lack of coordination, weakness, anxiety disorder (feelings of worry, anxiety, or fear). Resident 3's Minimum Data Set (MDS, an assessment tool), dated 9/8/2021, indicated his cognition was severely impaired. Review of the facility's Report of Suspected Dependent Adult/Elder Abuse, dated 9/19/2021, indicated staff reported that Resident 3 was observed by the nursing station and a sheet was around the resident while sitting on his wheelchair. During an interview with the Administrator (ADM) on 9/13/2021, at 12:10 p.m., ADM said that LVN A admitted to placing a sheet around Resident 3 due to increased agitation. During an interview with the medical records personnel (MRP) on 9/13/2021, at 12:47 p.m., the MRP said that on 9/9/21, at approximately 8:15 p.m., while at the nurse's station, she noticed a sheet wrapped around Resident 3's waist and it was tied around his wheelchair. Resident 3 was agitated and trying to get up from the wheelchair. MRP immediately reported her observation to the assistant director of nursing (ADON). During an interview with the ADON on 9/13/2021, at 1:14 p.m., she said that she immediately went to check on Resident 3 and found him sitting in his wheelchair and a sheet was wrapped around his waist. The ADON immediately instructed certified nursing assistant B (CNA B) and CNA C to remove the sheet around Resident 3. During a follow-up interview with the ADM on 10/20/2021, at 1:30 p.m., the ADM said that LVN A was terminated. ADM further stated that the facility has a "no restraint policy" and does not allow restraint even if the resident is agitated. Review of the facility's policy titled, "Use of Restraint," dated 9/2021, 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." "Restraints shall only be used to treat the resident's medical symptom(s) and never for discipline or staff convenience, or for the prevention of falls." In violation of the above cited standards, the facility failed to ensure Resident 3 was free from physical restraints when LVN A wrapped a sheet around Resident 3's waist while sitting in his wheelchair. This failure had the potential to compromise the resident's 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.