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F0689
D

Failure to Assess and Use Correct Sling Size During Mechanical Lift Transfers

Forman, North Dakota Survey Completed on 12-29-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to utilize appropriate assistive devices necessary to prevent accidents and/or injury for two residents observed during mechanical lift transfers. Specifically, staff did not assess or use the correct sling sizes for residents requiring full body mechanical lift transfers. For one resident, the sling used during transfer did not have a size noted, and for another, staff could not locate the resident's usual sling and instead used a large-sized sling without confirming its appropriateness. Staff interviews revealed that sling size information was only available on a chart in the supply room, and there was no individualized assessment or documentation of correct sling size for each resident. Further review and interviews confirmed that the facility had not assessed residents who require full body mechanical lifts for the appropriate sling size, nor had they provided staff with adequate information or education regarding proper sling selection. The lack of assessment and failure to ensure the use of correct sling sizes during transfers placed residents at risk for falls and injuries, as observed during the survey.

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