Try different approaches before using a bed rail. If a bed rail is needed, the facility must (1) assess a resident for safety risk; (2) review these risks and benefits with the resident/representative; (3) get informed consent; and (4) Correctly install and maintain the bed rail.
F700 in Iowa. Pick another state for the same tag.
Against expectation — 2024
Iowa cites F700 less often than its own record predicts
Versus expected share0.25×
0.25 times the national share — cited less often here than elsewhere.
Share of Iowa citations0.11%
Of every deficiency written in Iowa in 2024, this is the portion that was F700.
Iowa0.11%
National0.43%
Share of all citations that were F700.
Each state is measured against its own expected share, not against other states.
In the surveyor’s words
What Iowa surveyors wrote
F700 findings written in Iowa, one from each severity band recorded here, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
K · Immediate jeopardy, patternJune 27, 2024
Based on clinical record review, document review, observation, facility policy, resident, family and staff interviews, the facility failed to assess and reassess residents for the safe use of bed rails and failed to provide risks and benefit education to the resident and/or their legal representative, including entrapment and death since [DATE] for 3 of 3 residents sampled (Residents #68, #73, and #314). The failure resulted in the [DATE] death of Resident #73 when the staff found her with her head wedged between the bed rail and the mattress with injuries consistent with asphyxiation (suffocation). …
D · No harm, potential for more than minimal, isolatedMay 28, 2026
Based on observation, staff interview, clinical record review, and facility policy review, the facility failed to obtain informed consent prior to the installation of bed rails for 2 of 2 residents (Resident #4 and Resident #25) and failed to attempt bed rail alternatives prior to installation for 1 of 2 residents (Resident #25) reviewed for bed rails. The facility reported a census of 42. Findings include:1. Review of the Minimum Data Set (MDS) assessment, dated 5/13/26, revealed a Brief Interview for Mental Status (BIMS) score of 3 out of 15, which indicated severe cognitive impairment. The list of diagnoses included non-Alzhemier's dementia, stroke with hemiplegia (impaired mobility) affecting right dominant side, malnutrition, and anxiety disorder. …
C · No harm, potential for minimal, widespreadJanuary 9, 2020
Based on observation, clinical record review, and staff interview, the facility failed to obtain signed informed consent forms for four of five residents reviewed with side rail/grab bars on their beds ( Resident #2, #29, #41, & #52). The facility census was 59 residents.
Findings include:
1. Observation throughout the annual survey on 1/6-9/20, revealed beds used by Resident #2, #29, #41 & #52 have grab bars installed for the resident to use to assist with turning and bed mobility and no excessive gaps noted between the bed mattress, head boards, or foot boards that would indicate a risk of accidental resident entrapment and injury. …
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