Failure to Provide Requested Mattress Accommodation
Penalty
Summary
A deficiency was identified when a resident with multiple complex medical conditions, including cervical disc disorder with myelopathy, chronic venous hypertension with ulcers, COPD, diabetes, spinal stenosis, and a history of pressure ulcers, was not provided with a comfortable mattress despite repeated requests. The resident, who was dependent on staff for all activities of daily living and at moderate risk for skin breakdown, had a physician order for a low air loss mattress. Observations revealed that the air mattress in use was only partially inflated, causing the resident's buttock to rest against the bed frame. The resident reported having requested a new mattress several months prior, but no replacement had been provided. Staff interviews confirmed awareness of the resident's complaints regarding mattress comfort. Nursing staff were responsible for checking the mattress settings each shift and had determined the settings were appropriate. However, no attempts were made to obtain a replacement mattress, and the resident continued to experience discomfort. At the time of the survey, the resident had no current skin breakdown but did have scarring from previously healed wounds. The failure to provide a comfortable mattress following the resident's request constituted non-compliance with the requirement to reasonably accommodate resident needs and preferences.