Facility Evaluation Report

On 06/21/2023 Licensing Program Analyst (LPA) Evelin Rios conducted an announced Case Management - Deficiencies visit in conjunction with complaint control #31-AS-20230613163023. During physical plant tour at 11:06 a.m. while residents were being gathered for lunch in the dinning room, LPA observed resident#1(R1) restrained with an orange belt like strap that wrapped around R1's stomach and the back of the chair. R1 requested assistance from LPA stating they were unable to stand up. LPA immediately contacted the Resident Care Director Mary Jane Reyes who prompted staff #1(S1) to immediately remove the strap/restraint. Interview with S1 revealed strap/restraint is used to keep R1 from falling off chair. According to S1, R1 is able to move around the facility in their wheel chair freely but does not follow directions around meal time to stay seated while meals are being served. According to S1 the restraint allows staff to do other things and not worry about R1 having a fall. According to Mary she was unaware staff were using the restraint. According to Mary she confiscated the strap and will conduct an in-service meeting with staff about prohibiting the use of restraints.

Deficiency cited (refer to LIC809D) Exit interview conducted, a copy of this report and Appeal Rights provided.