Failure to Provide Properly Sized Bed to Accommodate Resident Needs
Penalty
Summary
The facility failed to reasonably accommodate a resident’s need for an appropriately sized bed, resulting in the resident’s feet pressing against the footboard whenever he was in his usual position. The resident, who was 73 inches tall and had incomplete quadriplegia at C5–C7 with chronic pain due to trauma, was cognitively intact and dependent on staff for self-care, bed mobility, and transfers. On multiple observations, the resident was seen in bed with the head of the bed elevated about 30 degrees, his head positioned approximately two inches below the top of the bed, and his legs straight with his feet pressed against the footboard. The resident reported that his feet hurt when they pressed against the footboard and stated he had requested a longer bed multiple times, as well as asking NAs to elevate his feet on pillows to relieve the discomfort. Staff interviews confirmed that the resident had repeatedly expressed discomfort and requested pillows under his feet because of the pressure against the footboard. A NA and a medical assistant both stated that when the head of the bed was raised, the resident’s feet pressed into the footboard and that they used pillows to elevate his feet at his request. During an observation with the DON, the resident again stated the bed was too small, and the DON acknowledged that his feet were pressed against the footboard, that the bed appeared too small, and that he could be at risk for skin breakdown. The DON also stated the resident had previously been in a longer bed before a room transfer but could not explain why he received a shorter bed afterward. The Maintenance Director reported that nursing staff were responsible for assessing bed size and entering work orders for larger beds, and confirmed that a work order for a longer bed for this resident was not received until the date of the survey interview, indicating that prior requests and observations had not resulted in timely accommodation.
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