Failure to Prevent Accident Hazards During Resident Transportation
Penalty
Summary
The facility failed to ensure that residents were free from accident hazards and did not provide adequate supervision to prevent accidents during transportation. Three residents experienced incidents related to unsafe transport practices. One resident, who was dependent on staff for transfers and used a wheelchair, reported falling to the floor of the facility van when the driver swerved to avoid another vehicle. The resident was not secured with a seatbelt, slid out of the wheelchair, and was assisted by dialysis clinic staff. The incident was not reported by the van driver or the resident to facility staff, and there was no documentation of the fall in the facility's records. Another resident complained about the van driver's unsafe and inattentive driving, stating that the driver was more focused on his drink than on the road. The administrator received this complaint and counseled the driver, but the unsafe driving behavior continued. A third resident, who was also dependent on staff for transfers and used a wheelchair, was not properly secured in the van. The van driver failed to attach one of the wheelchair hooks, causing the wheelchair to tip backward during transport. The resident sustained a skin tear and a bruise, complained of a headache, and was later sent to the emergency room for evaluation. The van driver did not notify facility staff or call emergency services at the time of the incident, instead continuing with the transport as planned. The van driver involved in these incidents had received periodic training on transportation safety and facility policies, which included instructions on securing residents and responding to emergencies. Despite this, the driver failed to follow established procedures, such as securing wheelchairs and reporting incidents. The facility's records indicate that the driver did not report falls or injuries as required, and interviews with staff and residents confirmed lapses in communication and adherence to safety protocols.