Failure to Honor Resident Rights to Outdoor Access and Self-Determination
Penalty
Summary
The facility failed to honor the rights of several residents to a dignified existence, self-determination, and communication by restricting their access to the front patio. This restriction was implemented after an incident in which a resident left the facility, went to the hospital, and became lost. Following this event, residents with BIMS scores less than 13 were no longer permitted to go outside unsupervised, regardless of their individual preferences or previous routines. Staff interviews confirmed that residents were only allowed outside when accompanied by staff, typically for 30 minutes at a time, and that this policy was based solely on BIMS scores, weather conditions, and perceived safety concerns. Multiple residents expressed dissatisfaction with the new restrictions, stating that they previously enjoyed the freedom to sit outside as they wished. One resident, who had severe cognitive impairment and required continuous oxygen, reported feeling upset and suffering due to the new limitations. Another resident with moderate cognitive impairment also expressed a desire to go outside more frequently, while a third resident indicated that the restrictions felt like punishment for the actions of another resident. Family members corroborated that these residents previously spent time outside unsupervised and that this activity was important to their well-being. Staff, including the DON and Administrator, stated that the decision to restrict unsupervised outdoor access was based on residents' BIMS scores and recent changes in their medical conditions. However, the facility did not conduct individualized assessments beyond the BIMS score to determine each resident's ability to safely use the patio unsupervised. The facility's policy referenced supporting residents' rights and making reasonable efforts to ensure safety, but in practice, the restriction was applied broadly without consideration of individual needs or preferences.