Other·September 15, 2022

§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. 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. On 7/8/2022 at 10:15 am, the California Department of Public Health (CDPH) conducted an unannounced visit to the facility to investigate a Facility Reported Incident (FRI) regarding quality of care. The facility failed to ensure Patient 3 was free from physical restraints (any manual method, physical or mechanical device, equipment, or material that is attached or adjacent to the patient’s body, cannot be removed easily by the patient and restricts the patient’s freedom of movement or normal access to his/her body) imposed for purposes of staff convenience that was not required to treat the Patient’s medical symptoms. This deficient practice had the potential for Patient 3 to be restricted from physical functioning and sustain injuries such as falls, strangulation or entrapment from attempts to free himself from the restraint. A review of Patient 3's Admission Record indicated the patient was admitted on 6/6/2022 with diagnoses that included a displaced intertrochanteric fracture of left femur (broken bone), history of falling, abnormalities of gait, and mobility. A review of Patient 3’s Minimum Data Set (MDS, a patient assessment and care screening tool), dated 6/12/2022, indicated Patient 3 had clear speech, sometimes understood others and sometimes made self-understood. Patient 3 required extensive assistance (patient involved in activity, staff provide weight-bearing support) with two persons physical assist for bed mobility and toilet use, with one-person physical assist for transfer, walk in room and personal hygiene. A review of Patient 3’s Change in Condition Evaluation, dated 7/7/2022, timed at 5:49 pm, indicated Patient 3 had a violation of patient’s rights to be free of restraints. During an interview on 7/8/2022 at 12:30 pm, the Director of Nursing (DON) stated on 7/7/2022, at 10 am, during daily standup meeting with all department heads, the Director of Rehabilitation (DOR) reported Resident 3 was physically restrained earlier that morning (7/7/2022). The DON stated the DOR observed a bedlinen tied on the bedframe across Patient 3’s lower body preventing Patient 3 from getting out of bed. The DON stated she and the Administrator (ADM) called the night shift Certified Nursing Assistant 1 (CNA 1) and CNA 1 stated she tied the bedlinen around Patient 3 because the patient tried to get out of bed. CAN 1 stated, "I didn't want him to fall and fracture his head or hip". CNA 1 stated she used the bedlinen to tie Patient 3 around 4:45 am. The DON stated putting a linen across the patient's body was considered a physical restraint. The DON stated all restraints need a physician’s order. The DON stated Patient 3 did not have an order for a restraint. The DON stated Patient 3 might get injured from attempting to free himself from the restraint. The DON stated Patient 3 could fall or become entrapped and possibly suffocate and be strangled in the bedsheet. During an interview on 7/8/2022 at 2 pm, the DOR stated on 7/7/2022 around 9 am, he went to Patient 3’s room, trying to sit the patient up at bedside and prepared the patient for treatment. Patient 3 told him, “something around me." The DOR stated he lifted the top blanket and saw a white linen over Patient 3's lower body. The DOR stated he saw the sheet tied onto the siderail or the bedframe. The DOR stated he forgot where exactly it was tied on. The DOR stated the linen was covered by the blanket and could not be seen from the outside. The DOR stated using a bedlinen preventing Patient 3 from standing up was a form physical restraint. The DOR stated using the bedlinen in this manner was dangerous. Patient 3 might fall and get injured if he tried to get out bed. A review of the facility’s policy and procedure, titled “Resident Rights Guidelines for All Nursing Procedures,” revised in October 2010, indicated patients are free from the use of any physical restraints, examples of physical restraints include: tucking in a sheet tightly so that the patient cannot get out of bed, or fastening fabric or clothing so that a patient’s freedom of movement is restricted. The facility failed to ensure Patient 3 was free from physical restraint imposed for purposes of staff convenience that was not required to treat the patient’s medical symptoms. This deficient practice had the potential for Patient 3 to be restricted from physical functioning and sustain injuries such as falls, strangulation or entrapment from attempts to free himself from the restraint. The above violations, jointly, separately, or in any combination, had a direct or immediate relationship to the health, safety, or security of Patient 3 and other patients residing in the facility.