Other·May 15, 2024

F604 §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) 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. 72319. Nursing Service - Restraints and Postural Supports. (a) Written policies and procedures concerning the use of restraints and postural supports shall be followed. (b) Restraints shall only be used with a written order of a licensed healthcare practitioner acting within the scope of his or her professional licensure. The order must specify the duration and circumstances under which the restraints are to be used. Orders must be specific to individual patients. In accordance with Section 72317, there shall be no standing orders and in accordance with Section 72319(i)(2)(A), there shall be no P.R.N. orders for physical restraints. (e) Restraints of any type shall not be used as punishment, as a substitute for more effective medical and nursing care, or for the convenience of staff. 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. (c) Each facility shall establish and implement policies and procedures, including but not limited to: (2) Nursing services policies and procedures which include: (E) Conditions under which restraints are used, the application of restraints, and the mechanism used for monitoring and controlling their use. 72527. Patient’s rights. (a) Patients have the rights enumerated in this section and the facility shall ensure that these rights are not violated. The facility shall establish and implement written policies and procedures which include these rights and shall make a copy of these policies available to the patient and to any representative of the patient. The policies shall be accessible to the public upon request. Patients shall have the right: (24) To be free from psychotherapeutic drugs and physical restraints used for the purpose of patient discipline or staff convenience and to be free from psychotherapeutic drugs used as a chemical restraint as defined in Section 72018, except in an emergency which threatens to bring immediate injury to the patient or others. If a chemical restraint is administered during an emergency, such medication shall be only that which is required to treat the emergency condition and shall be provided in ways that are least restrictive of the personal liberty of the patient and used only for a specified and limited period of time. An unannounced visit was conducted by California Department of Public Health on 4/2/2024 at 9 AM to investigate a facility reported incident regarding an allegation of employee- to- patient abuse. The facility failed to ensure Patient 1 was free of unnecessary physical restraint (any direct physical contact where the intention of the person intervening is to prevent, restrict, or subdue movement of the body, or part of the body of another person). On 4/1/2024 at 3:30 am, Licensed Vocational Nurse (LVN) 2 and LVN 3, tied Patient 1 with a white linen from waist down to the feet, and tied at the back of the wheelchair which restricted the patient from movement and getting up from her wheelchair. This deficient practice resulted to unnecessary physical restraint and placing the patient at risk of physical harm from impeding the circulation of patient's whole body from the restraint cause psychosocial harm, skin break down for Patient 1. During a review of Patient 1’s admission record, indicated Patient 1 is an 81-year- old- female who was initially admitted to the facility on 1/4/2023 and readmitted on 3/22/2024, with diagnoses of, unspecified cerebrovascular disease (a group of conditions that affect blood flow and the blood vessels in the brain), encounter for attention to gastrostomy (a surgical opening into the stomach. a gastrostomy may be used for feeding, usually via a feeding tube called a gastrostomy tube) dysphagia (swallowing difficulties) and anxiety disorder (persistent and excessive worry that interferes with daily activities). During a review of Patient 1's Minimum Data Set (MDS- a comprehensive assessment and screening tool) dated 1/3/2024, the MDS indicated Patient 1 was assessed not being able to follow commands, and required moderate assistance with the toilet, personal hygiene, change of position and transfer. A review of the Patient 1 history and physical, dated 1/12/2024, indicated Patient 1 does not have the capacity to understand and make decisions. During an interview on 4/2/2024 at 10:01 am, with the Director of Nurses (DON), the DON stated LVN (Licensed Vocational Nurse) 1 reported to her about Patient 1 being restrained by a fitted bedsheet to her own wheelchair on the morning of 4/1/2024 near Nursing Station 1 at 7:15 am. During an interview on 4/2/2024 at 11:32 am, with LVN 1, LVN 1 stated she was checking for Patient 1’s G-tube (a tube inserted through the belly that brings nutrition directly to the stomach site) for assessment around 8 am on 4/1/2024 in the shower room with Certified Nursing Assistant 1 (CNA1) and Patient 1. LVN1 stated CNA1 reported to her about Patient 1 being restrained by a white linen/ bed sheet in her wheelchair on 4/1/024 morning when CNA1 came to work on 4/1/20224 morning around 7:05 am. During a telephone interview on 4/2/2024 at 12:58 pm, with (CNA1). CNA1 stated Patient 1 was not in her own room. CNA1 stated she found Patient 1 in Nursing Station 1 near the front lobby area as soon as she arrived at work around 7 am on 4/1/2024. CNA1 stated Patient 1 was in her wheelchair with a white linen/ bedsheet tied around the patient’s waist to the back of her own wheelchair on 4/1/2024 around 7 am. CNA1 stated she reported Patient 1 being restrained to LVN 1. During an observation and interview on 4/2/2024 at 9:25 am in Patient 1’s room, CNA3 and LVN1 was changing Patient 1. Patient 1 was asked if she knew where she is, and Patient 1 stated “I do not know my name”. During a telephone interview on 4/2/2024 at 3:55 pm, with LVN 3, LVN3 stated she was assisting LVN2 to monitor Patient 1 for the night of 3/31/24 for the shift of 11 pm to 7 am of 4/1/2024. LVN3 stated LVN2 and LVN3 had tried to put Patient 1’s abdominal binder on (compression belts that encircle abdomen) backwards, but Patient 1 was able to remove it. LVN3 stated LVN2 and her then tried to put a white bed sheet around Patient 1’s waist area to prevent her from pulling out her G-tube again. LVN3 stated the time was near 4 am when they tied Patient 1’s waist with a white bedsheet and tied it at the back of wheelchair. During a concurrent interview and facility’s surveillance video located at Nursing Station 1 review on 4/2/2024 at 4:15 pm with the DON and Administrator (ADM), the DON and ADM validated in the surveillance video time stamped on 4/1/24 at 3:30 am Patient 1 sitting on the wheelchair while LVN 2 and LVN 3 tying Patient 1 with a white linen around the waist and tied it to the back of the wheelchair. The facility’s video surveillance also showed, LVN2 and LVN3 placing a patient gown on top of the tied white bed sheet. During a concurrent interview and record review on 4/3/2024 at 2:25 pm with the DON, the facility’s policy, and procedure (P&P) titled, Use of Restraints, revised in April 2017 was reviewed. The P & P indicated, “Physical Restraints” are defined as any manual method or physical or mechanical device, material or equipment attached or adjacent to the patient's body that the individual cannot remove easily, which restricts freedom of movement or restricts normal access to one's body. The DON stated LVN2 and LVN3 should have tried to put Patient 1’s abdominal binder back a few more times to R1 instead of tying the patient with a white bedsheet to her wheelchair. During a concurrent interview and record review on 4/3/2024 at 2:30 pm with ADM, ADM stated LVN2 and LVN3 were not supposed to use white linen or bed sheets to restraint patient in the facility. Physical restraints are only used for safety purpose after trying other less restrictive alternatives. A record review of the policy entitled, "Use of Restraints," revised April 2017, indicated practices that inappropriately utilize equipment to prevent patient mobility are considered restraints and are not permitted, including using bedrails to keep a patient from voluntarily getting out of bed as opposed to enhancing mobility while in bed; b. tucking sheets so tightly that a bed-bound patient cannot move; c. placing a patient in a chair that prevents the patient from rising; and d. placing a patient who uses a wheelchair so close to the wall that the wall prevents the patient from rising. The policy also indicated prior to placing a patient in restraints, there shall be a pre-restraining assessment and review to determine the need for restraints. The assessment shall be used to determine possible underlying causes of the problematic medical symptom and to determine if there are less restrictive interventions (programs, devices, referrals, etc.) that may improve the symptoms. The facility failed to ensure Patient 1 was free of unnecessary physical restraint (any direct physical contact where the intention of the person intervening is to prevent, restrict, or subdue movement of the body, or part of the body of another person). On 4/1/2024 at 3:30 am, Licensed Vocational Nurse (LVN) 2 and LVN 3, tied Patient 1 with a white linen from waist down to the feet, and tied at the back of the wheelchair which restricted the patient from movement and getting up from her wheelchair. This deficient practice resulted to unnecessary physical restraint and placing the patient at risk of physical harm from impeding the circulation of patient's whole body from the restraint cause psychosocial harm, skin break down for Patient 1. The above violation had a direct or immediate relationship to the health, safety, or security of Patient 1.