Health inspection·August 27, 2021

F700 §483.25(n) Bed Rails. The facility must attempt to use appropriate alternatives prior to installing a side or bed rail. If a bed or side rail is used, the facility must ensure correct installation, use, and maintenance of bed rails, including but not limited to the following elements. §483.25(n)(1) Assess the resident for risk of entrapment from bed rails prior to installation. §483.25(n)(2) Review the risks and benefits of bed rails with the resident or resident representative and obtain informed consent prior to installation. §483.25(n)(3) Ensure that the bed’s dimensions are appropriate for the resident’s size and weight. §483.25(n)(4) Follow the manufacturers’ recommendations and specifications for installing and maintaining bed rails. T22 72523. Patient Care Policies and Procedures. (a) Written patient care policies and procedures shall be established and implemented to ensure that patient related goals and facility objectives are achieved. The facility failed to attempt the use of appropriate alternatives prior to the installation of bed rails (adjustable metal or rigid plastic bars that attach to the bed) for three of three sampled residents (Residents 56, 66, and 76). This deficient practice placed Residents 56, 66 and 76 at risk for entrapment (an event in which a resident is caught, trapped, or entangled in a space) and injury from the use of bed rails. a. A review of Resident 56's Admission Record indicated the resident was admitted to the facility on 3/24/2021, with diagnoses that included chronic obstructive pulmonary disease ([COPD] a group of lung diseases that block airflow and make it difficult to breathe) and epilepsy (a disorder in which nerve cell activity in the brain is disturbed, causing seizures). A review of Resident 56's Physician Order Sheet dated 6/7/2021, indicated an order for the staff to use quarter length bed rails when Resident 56 was in bed for safety precautions due to seizure disorder. A review of Resident 56's Minimum Data Set ([MDS] a standardized assessment and care planning tool) dated 6/10/2021, indicated the resident was assessed with short and long- term memory problems. Resident 56 required total dependence (full staff performance every time during entire 7-day period) in all levels of activities of daily living with one to two-person physical assist. During an observation on 7/13/2021 at 10:24 am, Resident 56 was lying in bed with bilateral quarter length bed rails in the upright position and had an ongoing gastrostomy tube feeding (an opening into the stomach from the abdominal wall, made surgically for the introduction of food) of Nephro at 40 milliliter (ml, a unit of measurement for liquids) per hour through an enteral feeding pump (an electronic medical device that controls the timing and amount of nutrition delivered to a patient). Resident 56 was non-communicative. During an interview and concurrent record review on 7/14/2021 at 11:12 am, Registered Nurse 2 (RN 2) stated Resident 56's medical record did not contain information of appropriate alternatives to bed rails that were attempted prior to installation for the resident. RN 2 stated the bed rails could cause serious injury and/or death of a resident from entrapment of limbs or neck in between the bed rails. RN 2 also stated Resident 56 is at risk of being injured from the bed rails during seizure activity. b. A review of Resident 66's Admission Record indicated the resident was admitted on 6/14/2021, with diagnoses that included epilepsy and diabetes mellitus (high blood sugar in the blood). A review of Resident 66's Physician Order Sheet dated 6/14/2021, indicated an order for the staff to use quarter length bed rails when Resident 66 was in bed for safety precautions due to seizure disorder. A review of Resident 66's MDS dated 6/20/2021, indicated the resident was assessed with short and long- term memory problems. Resident 66 required extensive assistance (staff provide weight- bearing support) in most levels of activities of daily living with one-person physical assist. During an observation on 7/12/2021 at 10:41am, Resident 66 was observed lying in low bed with non-skid mattress on both sides of his bed. The resident's bilateral quarter length bed rails were in an upright position. Resident 66 was alert and spoke Spanish as a primary language. The Certified Nursing Assistant (CNA 5) who was present at that time was the interpreter for Resident 66. Resident 66 stated he did not know why his bed rails were always up. During an interview and concurrent record review on 7/14/2021 at 11:20 am, RN 2 stated, a resident with diagnosis of seizure disorder would still be safe in bed when appropriate alternatives to bed rails were used. She stated the use of appropriate alternatives to bed rails were necessary to prevent entrapment, injury and/or death of the resident. RN 2 stated, there was no documented evidence of appropriate alternatives attempted prior to the installation of bed rails for Resident 66. c. A review of Resident 76's Admission Record indicated the resident was admitted on 6/22/2021, with diagnoses that included hypertensive heart disease (heart problems that occur because of high blood pressure that is present over a long time). A review of Resident 76's Physician Order Sheet dated 6/22/2021, indicated an order for Resident 76 to use quarter length bed rails for positioning and ease of mobility as enabler. A review of Resident 76's MDS dated 6/28/2021, indicated the resident was assessed with short and long-term memory problems. Resident 76 required extensive assistance in all levels of activities of daily living with one-person physical assist. During an observation on 7/12/2021 at 11:20 am, Resident 76 was observed lying in bed watching the television. The resident only speaks and understand Spanish language. CNA 5 was the interpreter for Resident 76. Resident 76 stated she could turn and reposition herself in bed without holding on the bed rails. The resident stated the staff did not tell her why she should have bed rails. During an interview and concurrent record review on 7/14/2021 at 11:28 am, RN 2 stated, bed rails were applied upon admission of Resident 76 to the facility on 6/22/2021, without attempting the use of appropriate alternatives before its installation. RN 2 stated according to facility's policy titled, "Bed rails assessment" dated 8/2017, staff should attempt the use of alternatives to bed rails and when the alternatives failed to meet the resident's assessed needs, the resident should be assessed for risk of entrapment before the bed rails were to be installed. RN 2 stated the facility's policy for the use of bed rails was not followed for Residents 56, 66 and 76. The facility failed to attempt the use of appropriate alternatives prior to the installation of bed rails (adjustable metal or rigid plastic bars that attach to the bed) for three of three sampled residents (Residents 56, 66, and 76). This deficient practice placed Residents 56, 66 and 76 at risk for entrapment (an event in which a resident is caught, trapped, or entangled in a space) and injury from the use of bed rails. The above violation had a direct or immediate relationship to the health, safety or security of Residents 56, 66, and 76.