Failure to Implement Restorative Nursing Programs
Penalty
Summary
The facility failed to provide physician-ordered services to maintain mobility for two residents and did not maintain a restorative nursing program for two residents. Resident 85, who had a severe cognitive impairment, was discharged from physical therapy with a recommendation to ambulate 200 to 300 feet with a rolling walker and supervision. However, documentation revealed that the restorative nursing program was only completed once between October 2024 and December 2024, despite the therapy recommendations. Resident 73 had an active physician's order to ambulate 100 feet with a roller walker and supervision, but the restorative ambulation program was not completed twice daily as ordered. Documentation showed that the program was not completed at least once on several days in January 2025. Resident 73 reported that staff had not walked with her as required, and staff comments suggested a lack of follow-through on the restorative program. Resident 98, who had been discharged from therapy with a good prognosis for maintaining his current level of functioning, did not receive the recommended restorative nursing program. The program included ambulating up to 250 feet with a rolling walker and performing range of motion exercises. There was no evidence that this program was ordered, implemented, or completed after the resident's therapy ended. Interviews with staff confirmed these deficiencies in the restorative nursing programs for the residents.
Plan Of Correction
The facility is unable to retroactively provide physician ordered services for residents 73 and 98 and maintain the restorative nursing programs for residents 85 and 98. Orders for restorative programs will be reviewed to determine if they are still applicable. Orders that are still appropriate will be implemented. The facility will review physician ordered restorative nursing programs to ensure that the restorative nursing services are provided as ordered. Education will be provided to Licensed Nurses on implementing orders for restorative programs. The facility will educate CNAs on the importance of following physician orders for restorative nursing. The DON or designee will audit restorative nursing programs of 3 residents x5 a week for 8 weeks to ensure completion. The results of the audits will be reviewed at the facilities QAPI meeting for recommendations.