| 15 |
WINSTON COUNTY NURSING HOME |
255072 |
17560 EAST MAIN STREET |
LOUISVILLE |
MS |
39339 |
2016-02-24 |
221 |
D |
0 |
1 |
MMRK11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, staff interview, facility policy review, record review and resident interview, the facility failed to ensure that a resident was free from physical restraints as evidenced by Resident #11 had a self release seat belt that she was unable to release upon command for one (1) of three (3) residents reviewed with a self release seat belt. (Resident #11). Findings Include: Facility policy titled, Restraint Use, with a revision date of 8/29/14 revealed, the purpose is to provide residents with physical safety if the resident is at risk to cause harm to themselves. Procedure #3 stated, physical restraints may be defined as a waist belt, roll belt, lap buddy or geri-chair with a tray. During an interview at 9:30 AM on 2/24/16, the Director of Nursing (DON) stated, Resident #11 can release the seat belt, so the facility does not consider it a restraint. At 10:40 AM on 2/24/16, an observation revealed Resident #11 sitting in her wheelchair in her room with the self release seat belt across her waist, attached to the wheelchair. LPN #1 asked Resident #11 to release the self release seat belt. Resident #11 stated, I rarely ever am able to release it. LPN #1 instructed resident to unhook the belt. Resident #11 stated, No. Resident #11 was observed pushing and pulling on the belt and buckle. Resident #11 stated, I can't do it, I'll give it to you, you do it. LPN #1 instructed Resident # 11 to push red button. Resident #11 attempted to push release button, but was unable to push in enough to release belt. Resident #11 attempted for four (4) minutes without releasing belt. LPN #1 stated, She is not going to be able today. She's having a bad day. A review of Resident #11's signed physician's orders [REDACTED]. At 10:45 AM on 2/24/16 an interview with the facility Administrator revealed, some days Resident #11 can remove the seat belt and some days she cannot. Administrator stated the facility is going to do a restraint reduction attempt to see if Resident #11 still needs the belt and will document belt as a restraint. At 11:15 AM on 2/24/16, an interview with the Minimum Data Set (MDS) Coordinator revealed, that if the resident is not able to release the self release seat belt, it should be considered a restraint. At 11:30 AM on 2/24/16, an interview with the DON revealed, if the resident cannot release the belt by herself, it should be considered a restraint. The facility consent for restraints form for Resident #11, dated 5/20/15, lists the self releasing seat belt as a type of restraint to be used. The consent form was signed by Resident #11's responsible party and two (2) witnesses. The Plan of Care Kardex for Resident #11, dated (MONTH) (YEAR), revealed, under the title of restraints, the self release seat belt. The manufacturer's guidelines for the seat belt revealed, Product is not intended to be used as a restraint .Seat belts are not considered to be restraints as long as the individual is capable of releasing the closures themselves. The facility admitted Resident #11 on 5/19/15 with [DIAGNOSES REDACTED]. A review of the Quarterly Minimum Data Sheet (MDS) with an Assessment Reference Date (ARD) of 1/31/16, revealed a Brief Interview of Mental Status (BIMS) score of one (1), indicating that Resident #11 had severely impaired cognition. |
2020-09-01 |