Failure to Provide and Accurately Document Restorative Nursing Services
Penalty
Summary
The facility failed to provide restorative nursing services (RNS) as ordered for a resident with significant mobility and neurological impairments. The resident, admitted with diagnoses including conversion disorder, dysarthria, anarthria, and unspecified neuropathy, had physician orders and a care plan specifying active-assisted range of motion (AAROM) exercises for both lower extremities, to be performed daily, five days per week, with 20 repetitions and three sets per session or as tolerated. Despite these orders, documentation and interviews revealed that the resident did not consistently receive the prescribed RNS, and in some cases, the services were not provided at all. Record reviews and interviews indicated that restorative nurse assistants (RNAs) documented providing RNS on days when they were not present or working, and in some instances, initialed flow sheets to indicate completion of services that were not performed. One RNA admitted to only partially completing the ordered exercises and, on some days, not providing the treatment at all due to time constraints, yet still documented the services as completed. The resident also reported that RNAs either did not provide the RNS or only completed part of the ordered exercises on certain days. The facility's policy required that restorative nursing care be provided as needed to promote optimal safety and independence, but the failure to follow physician orders and accurately document care resulted in the resident not receiving the full extent of prescribed RNS. Staff interviews confirmed that documenting unprovided care was considered willful falsification of medical records, and the director of staffing development was unable to confirm whether the resident received RNS on multiple dates when documentation was falsified.
Plan Of Correction
How corrective actions will be accomplished for those residents found to have been affected by the deficient practice: RNA 1 and RNA 2 are no longer employed in the facility. Additionally, on March 5, 2025, the Administrator or designee held a one-on-one in-service session with RNA 5 along with a counseling, focusing on the importance of following RNA orders for Resident 2 and other residents in the program. This training emphasized essential steps for enhancing compliance and ensuring that residents' needs are effectively met. How the facility will identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken: All residents have the potential to be affected by this deficient practice. On March 18th, 2025, the Director of Nursing (DON) or designee reviewed residents participating in the restorative nursing assistant (RNA) program to ensure that treatments were properly authenticated and administered, thereby preventing any further decline in range of motion (ROM). No additional findings were noted. What measures will be put into place or what systemic changes will the facility make to ensure that the deficient practice does not recur: The facility's Director of Staff Development (DSD) resigned on March 7, 2025. A new DSD is scheduled to be onboarded on March 19, 2025, and appropriate policies and procedures will be followed to ensure the timely and accurate completion of Restorative Nursing flow sheets. On March 20th, 2025, facility restorative nursing assistants (RNAs) participated in an in-service training session conducted by the Administrator or designee. The training emphasized the importance of adhering to RNA orders for residents and the necessity of accurate charting related to RNA treatments. The Director of Nursing (DON)/designee will review RNA treatments on a weekly basis to ensure that orders are being properly implemented and accurately documented. The Director of Staff Development (DSD)/designee will conduct random rounds during RNA treatments to verify that orders are being executed as specified. Any negative findings will be reported to the Administrator for further review. How the facility plans to monitor its performance to make sure that solutions are sustained: The DON/designee will provide any negative findings to QAPI committee monthly x 3 months for further monitoring and action planning as indicated or until QAA committee determines compliance. Date of Compliance: March 20th, 2025