Failure to Maintain Safe and Clean Wheelchairs for Two Residents
Penalty
Summary
The facility failed to maintain the wheelchairs of two residents in a safe and comfortable condition. Observations revealed that one resident's wheelchair had both armrests in disrepair, with one armrest severely frayed and only partially covered, and the other missing padding entirely, exposing bare metal. The back section of the same wheelchair was also partially missing its covering, exposing the foam underneath. Another resident's wheelchair had both armrests split and frayed, with exposed padding, and the resident reported that the armrests sometimes caused discomfort. Interviews with facility staff confirmed that managers were responsible for identifying wheelchair repairs and contacting maintenance, and that replacement pads were available. The Therapy Manager and DON both acknowledged that the damaged armrests and back support should have been replaced, noting that the cracked surfaces could not be adequately cleaned and could cause skin issues. Clinical records indicated that both residents used wheelchairs for mobility and had diagnoses that included mobility impairments. The DON stated that the condition of the wheelchairs should have been reported and addressed by nursing staff.