Failure to Provide Restorative Nursing Programs
Penalty
Summary
The facility failed to ensure that restorative nursing programs were provided according to the resident's plan of care for one resident. The deficiency was identified through a review of facility policies, clinical records, and interviews with residents and staff. The facility's policy on restorative nursing programs required individualized programs with measurable goals, overseen by a restorative nursing coordinator, and documented by restorative aides. However, documentation for the resident's restorative active range of motion and ambulation programs was missing on multiple dates. The resident involved was cognitively intact and required substantial assistance with lower body dressing, moderate assistance with upper body dressing, and substantial assistance with transfers and ambulation. The resident had a diagnosis of Parkinsonism, which affects movement. The care plan included a restorative active range of motion program using weights and a restorative ambulation program with a walker, both of which were not consistently documented as completed. Interviews with staff confirmed the lack of documentation and completion of the restorative programs as per the care plan. The Nursing Home Administrator acknowledged the absence of documented evidence for the completion of the resident's restorative programs on the specified dates and shifts. This lack of adherence to the care plan and documentation requirements led to the identified deficiency.
Plan Of Correction
An immediate remedy could not be implemented for Resident 29 as events occurred in the past. To ensure compliance and accuracy going forward, active range of motion for the certified nursing assistant to complete was added to this resident. An audit/review of all other residents' restorative nursing plans was completed. Active range of motion for the certified nursing assistant was added to those residents who had an active range of motion program assigned to the Restorative Nursing Assistant. The Restorative Nursing Program policy was reviewed by Nursing Management and the Medical Director; the policy was updated. This policy will be educated and reviewed with all current Healthcare Nursing Staff, and acknowledgements will be obtained and documented. All newly hired staff, as well as temporary (agency) staff, are to be educated on the Restorative Nursing Program/Policy Schedule and Execution of Tasks. An additional Restorative Nursing Assistant to fill in when the Restorative Nurse Aide is absent has been identified and trained. The Director of Nursing, Assistant Director of Nursing, Healthcare Nursing Leadership, or designee will conduct audits for staff compliance with documentation of the Restorative Nursing Program daily for two weeks, then weekly for six weeks, then monthly for four months. On-the-spot education will be provided to staff as needed. The results of these logs/audits, along with a Root Cause Analysis of any identified issues, will be brought to the Quality Assurance and Performance Improvement Committee for two quarters for further analysis and corrective action as needed. The committee will determine the need for additional audits or reporting.