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 Ohio. Pick another state for the same tag.
Against expectation — 2025
Ohio cites F700 less often than its own record predicts
Versus expected share0.08×
0.08 times the national share — cited less often here than elsewhere.
Share of Ohio citations0.03%
Of every deficiency written in Ohio in 2025, this is the portion that was F700.
Ohio0.03%
National0.39%
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 Ohio surveyors wrote
F700 findings written in Ohio, 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.
J · Immediate jeopardy, isolatedAugust 25, 2026
Based on medical record review, observation, staff interview, review of Self-Reported Incident (SRI) reports, review of the United States (US) Food and Drug Administration (FDA) Guide to Bed Safety: Bed Rails in Hospitals, Nursing Homes and Home Healthcare, review of the suffocation and strangulation hazard tag on bed rail, review of bed rail safety warning and assembly instructions, and policy review, the facility failed to thoroughly assess residents for the risk of entrapment and appropriateness for the use of bedrails. This resulted in Immediate Jeopardy and death for Resident #1 when the resident was found unresponsive and without vital signs with his head and neck through the opening of the bedrail on the left side of his bed. …
Based on closed medical record review, staff interviews, review of staff witness statements, review of the hospital notes, and review of the facility policy, the facility failed to ensure bed rails were properly installed. This resulted in Actual harm to Resident #89 when on 10/11/25 the facility applied bed rail broke off during resident care, causing the resident to roll out of bed, be lowered to the floor by staff, and maneuvered onto a Hoyer pad. Consequently, Resident #89 sustained a displaced fracture of the right humeral neck (upper arm). This affected one (#89) of three residents reviewed for falls. The facility census was 86.Findings include:Review of the closed medical record revealed Resident #89 was admitted on [DATE] and discharged on 10/25/25. …
D · No harm, potential for more than minimal, isolatedJune 25, 2026
Based on medical record review, observation, staff interview, and review of facility documents, the facility failed to ensure alternatives to bed rails were attempted and failed to provide ongoing monitoring and supervision for a resident who utilized a bed rail. This affected one (Resident #1) of one resident reviewed for bed rail safety. The facility census was 119.Findings include:Review of the medical record for Resident #1 revealed she was admitted on [DATE] with diagnoses including Alzheimer's disease and lack of coordination. …
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