Failure to Provide Properly Fitting Linens for Bariatric Mattress
Penalty
Summary
The facility failed to reasonably accommodate a resident’s needs and preferences by not maintaining linens that properly fit a bariatric specialty mattress. The resident, who was admitted with COPD and morbid obesity and was cognitively intact with a BIMS score of 15, reported that the facility did not have sheets that fit her bariatric bed. Surveyor observations on multiple occasions showed the resident’s bed either with only a partially tucked flat sheet and no fitted sheet, or with a fitted sheet that had come off the upper corner of the mattress. The resident stated that the facility had only two sets of sheets that fit her mattress, that staff could not always find them, and that when incorrect or half sheets were used, they did not stay on the mattress. Staff interviews confirmed an ongoing shortage of properly sized bariatric sheets. One CNA stated there were not enough sheets for bariatric beds, and another CNA acknowledged that they did not really have enough bariatric-size sheets and that the resident specifically requested sheets with orange stitching because those were the only ones that fit, while the green stretchy sheets did not really work. The Housekeeping/Laundry Supervisor reported finding only three sheets that fit the resident’s bed, stated that previously purchased sheets were the wrong size, and indicated he did not know how many bariatric beds were in the facility and would need to count sheets to determine if there were enough. The Administrator could not explain why the resident did not have properly fitting sheets, and the facility was unable to provide a policy related to supplies. The resident’s care plan did not address linens or mattress needs in any focus area or intervention.
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