The facility failed to ensure residents were free of physical restraints for 1 of 3 resident reviewed. on at 12:45. Resident #1 remained in the activity room with no facility staff in the area. She was noted to be grunting and banging pushing on the tray table in front of her until staff walked in the room with her lunch tray and began assisting her.
During an interview on at 2:15 pm with Staff C, CNA assigned to care for Resident #1. She conﬁrms that Resident was left in the chair with the tray table in front of her since this morning. She says they normally provide incontinence care to the residents in the morning around breakfast and after lunch. There was no information offered as to why the tray remained in place when meals are not being served.
During an interview on _, at 2:20 pm with Staff A, LPN, she was made aware of the ﬁndings and said that Resident #1 usually has a hospice staff with her but she called out today. She says that the staff are supposed to remove the tray and let her move around and she will instruct the staff .