(p 302) "Accident" refers to any unexpected or unintentional incident, which results or may result in injury or illness to a resident. . . .
"Avoidable Accident" means that an accident occurred because the facility failed to:
Identify environmental hazards and/or assess individual risk of an accident, including the need for supervision and/or assistive device; and/or
Evaluate/analyze the hazards and risks and eliminate them, if possible, or, if not possible; identify and implement measures to reduce the hazards/risk as much as possible; . . .
(p 303) "Unavoidable Accident" means that an accident occurred despite sufficient and comprehensive facility systems designed and implemented to:
Identify environmental hazards and individual resident risk of an accident, including the need for supervision; . . .
"Assistive Device" refers to any item (e.g., fixtures such as handrails, grab bars, and mechanical devices/equipment such as stand-alone or overhead transfer lifts, canes, wheelchairs, and walkers, etc.) that is used by, or in the care of a resident to promote, supplement, or enhance the resident's function and/or safety.
"Environment" refers to any environment or area in the facility that is frequented by or accessible to residents, . . .
"Fall" refers to unintentionally coming to rest on the ground, floor, or other lower level, . . .
"Hazards" refer to elements of the resident environment that have the potential to cause injury or illness.
- "Hazards over which the facility has control" are those hazards in the resident environment where reasonable efforts by the facility could influence the risk for resulting injury or illness.
- (p 304) "Free of accident hazards as possible" refers to being free of accident hazards over which the facility has control.
"Risks" refers to any external factor, facility characteristic (e.g., staffing or physical environment) or characteristic of an individual resident that influences the likelihood of an accident. [The higher the risk, the less profitable a facility can be expected to be.]
"Supervision/Adequate Supervision" refers to an intervention and means of mitigating the risk of an accident. Facilities are obligated to provide adequate supervision to prevent accidents. Adequate supervision is determined by assessing the appropriate level of supervision and number of staff required, the competency and training of the staff, and the frequency of supervision needed. This determination is based on the individual resident's assessed needs and identified hazards in the resident environment. Adequate supervision my vary from resident to resident and from time to time for the same resident.
[Margaret was safe and secure in her wheelchair all day (10 Feb) in the public areas of memory care until we brought her to our apartment. She hit the floor within 30 minutes on two falls with me watching. One potential fall was avoided by me running for help in time to avoid it. It took two caregivers to put her back each time. We fastened the lap belt and had no more problem as she played with her keepsakes and I continued writing.]
(p 309) The interventions listed below include supervision and other actions that could address potential or actual negative interactions.
- Evaluating staffing levels to ensure adequate supervision (if it is adequate, it is meeting the resident's needs) . . .
- Evaluating staffing assignments to ensure consistent staff who are more familiar with the resident and who thus may be able to identify changes in a resident's condition and behavior;
- Providing safe supervised areas for unrestricted movement.
(p 311) NOTE: Challenging a resident's balance and training him/her to recover from loss of balance is an intentional therapeutic intervention. The losses of balance that occur during supervised therapeutic interventions are not considered a fall.
(P312) NOTE; A fall by a resident does not necessarily indicate a deficient practice because not every fall can be avoided.
Margaret cannot operate the lap belt release button as installed. I will reinstall it with the ends reversed so she may be able to use her left hand (making it a non-restraint). We need the lap belt in our apartment as she fell even with me watching ever couple of minutes.
Her fall in the patio area is also left unsettled. As are the corrections needed to prevent another resident being driven into the iron fence with the possibility of greater injuries, or if she gains access to the tilted endless path on the patio in her wheelchair before she can use her hands to brake.
For Missouri, Title 19--Department of Health and Human Services, Division30--Division of Health Standards and Licensure, Chapter 85--Intermediate Care and Skilled Nursing Facility, construction standards . . . include:
19 CSR 30-85.012(2) . . . The facility shall prepare and submit working drawings and specification, complete in all respects, for approval by the division. These plans shall cover all phases of the construction project, including site preparation; paving; general construction; . . .
The sloped lawn hazard seems to have evaded the architect, the State, the City, and the annual HHS inspection as well as Provision Living at Columbia.
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