Failure to Prevent Accident Hazards for Cognitively Impaired Resident
Penalty
Summary
A cognitively impaired resident with multiple diagnoses, including dementia, encephalopathy, and depression, was found to have unsupervised access to razors in her room. The resident had a documented history of using her husband's razor without supervision, which resulted in a skin abrasion on her left jaw. Clinical records and nursing notes confirmed that the resident admitted to using the razor and sustained an abrasion as a result. The facility's incident report corroborated these findings. During a subsequent observation, a blue razor without a protective top was found in the resident's wheelchair, and another blue razor was discovered in the bathroom cabinet. An electric razor belonging to the resident's husband was also observed plugged in on the bathroom counter. A licensed nurse removed the razors from the room and informed the resident that she should not have them. The facility failed to ensure that the resident's environment was free from accident hazards, as required by regulations, by allowing a cognitively impaired resident unsupervised access to razors.