IDPH has cited and fined Woodbridge Nursing Pavilion nursing home in Chicago after a resident suffered a broken leg during an unsafe transfer.
The citation that was issued in connection with this incident was eye-opening because it showed how little the staff knew about how to properly care for this resident.
The injury to this resident occurred when the resident’s psychologist found the resident sitting on the edge of the bed. An aide had left her sitting on the edge of the bed while she went to get a mechanical lift to transfer her to her wheelchair. The psychologist attempted to transfer her to a wheelchair, but in the process of doing so, lost control of the resident and had to call for help. A nurse came to his aid, but in the process of getting the resident to her wheelchair, she suffered a broken leg just above the knee.
Leaving a resident sitting on the edge of the bed is an invitation for disaster, as it can very easily lead to a nursing home fall, such as happened here. The resident was a known fall risk due to right-sided weakness and required a mechanical lift for transfers.
When the surveyor arrived at the nursing home to do her investigation into the injury to this resident, she spoke to the staff and learned:
- The nurse who was assigned to care for the resident the day of the inspection was unable to tell her anything about the resident, explaining that it was her second day on the job. She denied having been giving any special instructions about the care of the resident, denied that the previous nurse has given her any endorsement of the care of that resident, denied knowing whether there were any instructions for that resident to stay in bed, or whether that resident was a fall risk.
- The CNA assigned to care for the resident that day denied knowing whether the resident was a fall risk or whether there were special instructions for how to get her out of bed.
- The CNA assigned to care for her the day of her injury said that she left the resident sitting at the edge of her bed because that was what she always did and denied knowing that there were any special instructions as to how to transfer the resident.
Care for residents in a nursing home needs to be provided in an organized, systematic way. That is what the care planning process does – it determines what the basic care needs of the resident are and how those care needs will be met on a day-to-day, shift-to-shift basis. Staff caring for a resident need to know how to meet those needs – avoiding disaster is simply a matter of a good luck. Good luck is no substitute for good care. When the staff doesn’t know that a resident is a fall risk or what needs to be done to get her safely from bed, it is relying entirely on good luck. Sadly for this resident, good luck ran out.
One of our core beliefs is that nursing homes are built to fail due to the business model they follow and that unnecessary accidental injuries and wrongful deaths of residents are the inevitable result. Order our FREE report, Built to Fail, to learn more about why. Our experienced Chicago nursing home lawyers are ready to help you understand what happened, why, and what your rights are. Contact us to get the help you need.
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