Health inspection·October 26, 2021

72319. Nursing Service – Restraints and Postural Supports. (d) 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. §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. The facility failed to ensure Resident 1 was not restrained by Certified Nurse Assistant (CNA) 1, with a bedsheet while in bed. On 9/27/2020, CNA 2 found Resident 1’s feet tied together with a bedsheet. This failure resulted in Resident 1 not able to move her feet freely which had the potential to cause psychosocial harm such as depression, anxiety, and fear as well as physical harm such as pressure injuries due to inability to move and further decline in the resident’s physical functioning. A review of Resident 1's Admission Record indicated an 89 year old resident was admitted to the facility on 10/14/2019, with diagnoses that included Parkinson's disease (a disorder of the central nervous system that affects movement, often including tremors), dementia (a general term for the impaired ability to remember, think, or make decisions that interferes with doing everyday activities), mood disorder (a mental health problem that primarily affects a person's emotional state) and history of falls. A review of Resident 1’s Minimum Data Set (MDS; a care area assessment and screening tool) dated 10/9/2020, indicated the resident’s cognition (thought process) was severely impaired. The MDS indicated Resident 1 had clear speech and able to respond adequately to simple, direct communications only. The MDS indicated Resident 1 required limited assistance with one-person physical assistance for bed mobility and required extensive assistance with one-person physical assistance for transfers and walking. A review of the facility’s letter addressed to the Department of Public Health dated 9/29/2020, indicated a notification of an “alleged involuntary restraint/abuse” reported by CNA 2, allegedly committed by CNA 1. The facility letter indicated CNA 2 reported finding Resident 1 on 9/27/2020 at around 4 PM, with a bed sheet physically restraining Resident 1’s feet together, while lying in bed. The facility letter indicated when the facility staff interviewed Resident 1, the resident identified the morning shift (7 AM to 3 PM) CNA and verbalized CNA 1’s first name, “physically restrained” Resident 1’s feet with the bed sheet. During an interview on 10/14/2020 at 2:25 pm, the Administrator stated, CNA 2 reported observing Resident 1 in bed during her facility rounds moving around in bed and kept saying “My feet.” The Administrator stated CNA 2 stated observing Resident 1’s feet was tied together with a bed sheet on 9/27/2020 and Resident 1 could not move her feet. The Administrator stated CNA 2 informed CNA 3 and LVN 1 and all three of them went back to Resident 1’s room and untied Resident 1’s feet. The Administrator stated that they had interviewed Resident 1 three times in two separate days and Resident 1 was able to recall that CNA 1 tied her feet together with the bedsheet because “She does not want me to fall.” During an interview on 6/29/2021 at 11:45 am, CNA 2 stated, on 9/27/2020 when CNA 2 was doing her facility rounds, CNA 2 saw Resident 1's feet were “tied together with the bedsheet.” During an interview on 6/29/2021 at 4:05 pm, LVN 1 stated, when LVN 1 arrived at Resident 1’s room, Resident 1’s feet were wrapped tight together with the bedsheet. During a telephone interview, on 6/30/2021, CNA 1 stated Resident 1 told her Resident 1 asked her to wrap her feet with the blanket on 9/27/2020 before she left that day during the morning shift, because Resident 1 was cold. CNA 1 stated she had asked another CNA (unnamed) to go and see Resident 1 and that unknown CNA stated that she would take care of it. CNA 1 stated she needed to go home right away that day because it was already passed her time and did not see Resident 1 back, after wrapping her feet with the blanket. During a telephone interview, on 9/3/2021 at 1 pm, the Administrator stated the facility takes abuse incidents very seriously. The Administrator stated that physical restraints of any type should not be used for the residents in the facility. The Administrator stated that CNA 1 was terminated from the facility. A review of facility's policy titled “Restraints” dated 11/1/2017 indicated, physical restraint is 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 normal access to one's body. The policy indicated the facility would not use restraints on a “PRN” (as needed) or as necessary basis. The facility failed to ensure the 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, including but not limited to: The facility failed to ensure Resident 1 was not be restrained by Certified Nurse Assistant (CNA) 1, with the bedsheet while in bed. On 9/27/2020, CNA 2 found Resident 1’s feet tied together with a bedsheet. This failure resulted in Resident 1 not able to move her feet freely which had the potential to cause psychosocial harm such as depression, anxiety, and fear as well as physical harm such as pressure injuries due to inability to move and further decline in the resident’s physical functioning. This violation had a direct or immediate relationship to the health, safety, or security of patients or residents.