Failure to Provide Mobility Services and Equipment for Two Residents
Penalty
Summary
The facility failed to provide appropriate services, equipment, and assistance to maintain or improve mobility for two residents with significant medical needs. One resident, who had diagnoses including cerebral vascular accident with left hemiparesis and dysphagia, was cognitively impaired and required assistance with activities of daily living and mobility. Despite having physician orders allowing the resident to be up as tolerated, staff only assisted the resident out of bed for doctor's appointments, and the resident did not have a wheelchair provided by the facility. A family friend reported having to bring a wheelchair from outside, and staff confirmed that the resident was not routinely mobilized. Another resident, with multiple complex diagnoses such as tracheostomy, chronic kidney disease, and chronic respiratory failure, also had physician orders to be up as tolerated and to receive physical and occupational therapy evaluation and treatment. However, this resident had not been evaluated by therapy, had not received a wheelchair, and had not been mobilized since admission. Staff interviews revealed that the lack of insurance information delayed therapy evaluation and equipment provision, and there was no restorative program in place for this resident. Nursing and therapy staff were aware of the orders but did not initiate services or equipment pending insurance verification. Facility policies required assessment for restorative nursing programs and therapy services upon admission and as needed, but these were not consistently implemented. The Director of Nursing and Administrator acknowledged that residents should be evaluated and provided with necessary equipment and services regardless of insurance status, but there was no policy for equipment ordering for new admissions. The failure to follow physician orders and facility policy resulted in residents not receiving appropriate interventions to maintain or improve their mobility.