Failure to Provide Specialized Rehabilitative Services
Penalty
Summary
The facility failed to provide specialized rehabilitative services for three residents, as required by their comprehensive care plans. Resident R16, who was admitted with a right below-knee amputation, diabetes, and peripheral vascular disease, did not receive a timely consultation for a prosthetic as ordered by the physician. Despite the care plan indicating the need for therapy evaluation and treatment, there was no evidence of a physiatry consultation for a prosthetic, and the resident reported not having received a stump shrinker. The physical therapist was unaware of how to obtain the prosthetic, and the Director of Rehab confirmed the delay in evaluating and treating the resident. Resident R278, admitted with a below-knee amputation and other conditions, experienced a delay in starting physical therapy, which began seven days after admission. The resident expressed concerns about the delay in therapy, and the Director of Rehab acknowledged that there was no process in place for obtaining a stump shrinker. The Nursing Home Administrator and DON confirmed the facility's failure to provide the necessary specialized rehabilitative services for the residents involved.
Plan Of Correction
1. Residents experienced no adverse effects, and R127 and R278 will receive therapy services as ordered. 2. Whole house audit to be completed on physiatry consults and specialized rehabilitative services. 3. Resident R16 has since been consulted by physiatry and physical therapist is working with organization for prosthetic process. 4. DOR/designee to educate nursing staff and therapy staff on physiatry consults and specialized rehabilitative services. 5. DOR/designee to audit orders for physiatry consults and therapy consults 3x/week for 2 weeks, 2x/week for 2 weeks, and 1x/week for 2 weeks. 6. Results to be submitted to QAPI for review and approval.