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F0689
D

Failure to Ensure Safe Wheelchair Transport

Marion, Iowa Survey Completed on 04-09-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

A deficiency occurred when staff failed to ensure safe wheelchair movement for a resident with severe cognitive impairment and multiple diagnoses, including heart failure, dementia, and anxiety. The resident was documented as dependent on staff for wheelchair mobility. During an observation, a CNA was seen pushing the resident in a wheelchair without using foot pedals, resulting in the resident's left foot dragging on the ground for approximately 50 feet. The DON later confirmed that staff are expected to use foot pedals when transporting residents in wheelchairs. Additionally, the facility did not have a policy regarding the use of wheelchair foot pedals.

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