Failure to Care Plan Use of Bed Enabler Bars for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement comprehensive, person-centered care plans addressing the use of bed enabler bars for two residents, as required by facility policy. The facility’s policy on comprehensive person-centered care plans, revised March 2022, requires measurable objectives and timetables to meet residents’ physical, psychosocial, and functional needs. For one resident with diagnoses including hypertension and hemiparesis, surveyors observed bilateral enabler bars attached to the bed, and the resident reported using them to help position himself. Review of this resident’s interdisciplinary plan of care showed no care plan developed to address his use of enabler bars in relation to his diagnoses and bed mobility status, and the NHA confirmed that no such care plan existed. For another resident with diagnoses including GERD, hyperlipidemia, and dementia, surveyors observed bilateral enabler bars attached to the bed. The clinical record contained a bed rail evaluation and a consent form completed previously, but review of the care plan did not reveal any plan of care addressing the resident’s use of enabler bars based on his diagnoses and bed mobility status. In an interview, the NHA stated she would expect this resident to have a care plan developed for his use of bed rails. These findings demonstrate that, for both residents, the facility did not follow its own policy and regulatory requirements to develop and implement person-centered care plans that included the use of enabler bars.
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