Failure to Use Gait Belt During Resident Transfer
Penalty
Summary
A deficiency occurred when a certified nursing assistant (CNA) transferred a resident with severe cognitive impairment, Alzheimer's disease, hypertension, and muscle weakness from a wheelchair to a bed without using a gait belt, contrary to facility policy. The resident required maximum staff assistance for transfers, as documented in the facility assessment. During the observed transfer, the CNA lifted the resident by placing her arms under the resident's arms and pivoted her to the bed, while wearing a gait belt around her own waist but not using it on the resident. Both the CNA and the Director of Nursing later confirmed that a gait belt should have been used for the resident's safety, in accordance with the facility's policy requiring gait belt use for all assisted transfers unless contraindicated.