Failure to Assess and Document Bed Assist Bar Use
Penalty
Summary
The facility failed to properly assess the use of bed assist bars for a resident with multiple diagnoses, including stroke, dementia, epilepsy, weakness, and reduced mobility. Despite physician orders and care plan documentation indicating the use of bed assist bars for assistance with repositioning and mobility, the resident's Minimum Data Set (MDS) and Quarterly Evaluation did not reflect the use of these devices. Observations confirmed the presence of bilateral bed assist bars in use, and interviews with facility staff revealed that the required quarterly assessment for bed assist bar appropriateness had not been completed since the previous evaluation. The Assistant Director of Nursing and the MDS Coordinator both confirmed that the resident had not been evaluated for bed assist bar use as required, and that the documentation did not accurately reflect the current interventions in place. The lack of timely and accurate assessment and documentation for the use of bed assist bars constituted a failure to comply with regulatory requirements for resident safety and individualized care planning.