Failure to Provide Restorative Nursing Services
Penalty
Summary
The facility failed to consistently provide restorative nursing services as planned to maintain mobility for two residents, identified as B1 and B2, out of a sample of 34 residents. The facility's Restorative Nursing Services Policy, last reviewed on June 19, 2024, mandates that residents receive restorative care to promote safety and independence. However, the facility did not adhere to this policy for the two residents in question. Resident B1 was admitted with conditions including heart failure, hypertension, and asthma, and was severely cognitively impaired. The resident's care plan included a goal to ambulate 25-50 feet with assistance, but the restorative nursing program for ambulation was not provided on 5 out of 7 days as ordered. Similarly, Resident B2, who had a history of cerebral infarction and Parkinson's disease, was also severely cognitively impaired and required assistance for mobility. The care plan for Resident B2 included a goal to ambulate 50-75 feet with assistance, but the restorative nursing program was not provided on 6 out of 7 days as ordered. Interviews with the Director of Rehab and the Nursing Home Administrator confirmed that the facility failed to implement the planned restorative nursing programs for these residents. The documentation showed inappropriate use of "NA" (not applicable) as a response, indicating that the restorative services were not provided as required, which was acknowledged by the facility's administration.
Plan Of Correction
- B1 & B2 reassessed by therapy to determine current needs. - House audit completed on current residents to determine any decline in ROM/Mobility. Any resident who missed scheduled ROM exercises to receive a therapy evaluation to assess for potential functional decline, and interventions will be implemented as needed. - Facility policy entitled, "Restorative Nursing Services", updated to include documentation requirements, specifying the reason when ROM exercises are not provided. Policy will also include prohibiting the use of "NA" not applicable when charting and should give a reason for refusal. - Mandatory directed in-service training will be completed on 2/11/2025 for nursing staff, therapy staff, and administrative staff on ROM exercises. This would include but not limited to importance of consistent range of motion and proper techniques along with correct documentation. - Root cause analysis (RCA) completed with the assistance of the QAPI committee and governing body. The results of the RCA will be incorporated into the POC. - The DON or designee will conduct weekly audits x 4 weeks then monthly x 2 to ensure staff compliance with ROM procedures and documentation. - Audits will be presented at the monthly QAPI committee for ongoing oversight.