Failure to Maintain and Inspect Mechanical Lifts Resulting in Resident Injury
Penalty
Summary
The facility failed to properly maintain and inspect mechanical lifts used for resident transfers, resulting in an incident involving a resident with multiple medical conditions, including cardiomegaly, congestive heart failure, morbid obesity, and cervical stenosis. The resident, who was dependent on staff for mobility and required a two-person mechanical lift for all transfers, was being moved when the lift tilted to the right and the sling bar struck the resident on the forehead, causing moderate swelling. The incident occurred while two staff members were assisting the resident, and it was later determined that a mechanical strut on the lift had broken, causing the floor legs to fold back and the lift to tilt. Review of facility records revealed that no routine inspections or maintenance had been completed or documented for the mechanical lifts in use, despite manufacturer guidelines requiring inspection of all mechanical parts at least every six months. Interviews with facility leadership confirmed the absence of inspection records. The lack of proper maintenance and inspection of the mechanical lift directly contributed to the equipment failure and subsequent resident injury.