Failure to Implement Restorative Program for Resident with Limited Mobility
Penalty
Summary
The facility failed to provide appropriate care to maintain or improve range of motion (ROM) and mobility for a resident with a history of cerebrovascular accident (CVA), lymphedema, and a chronic non-pressure ulcer. The resident had documented impaired ROM on one side of the body and required varying levels of assistance for ambulation and transfers. After discharge from physical therapy, the resident was recommended for a functional maintenance program (FMP) that included ambulation with a four-wheeled walker and use of an exercise bike for upper and lower extremity ROM. However, the care plan did not include details about the resident's ambulation status or a restorative or functional maintenance exercise program. Review of the resident's records showed inconsistent implementation of the recommended FMP. Documentation indicated that ambulation and exercise activities were either not attempted, refused, or inconsistently performed, with only two recorded uses of the therapy bike over several months. The resident reported that staff were often too busy to assist with walking and that he spent most of his day sitting, which contributed to the development of a sore on his buttock. Observations confirmed that the resident was frequently seated in his room or recliner, and staff interviews revealed that the facility did not have a restorative aide to implement or oversee restorative programs. Therapy staff confirmed that recommendations for FMPs were provided to nursing, but the frequency and implementation were left to nursing staff discretion. The facility's policy required that therapy referrals for restorative programs be implemented by a restorative nurse or aide, but in practice, there was no designated staff to carry out these programs. As a result, the resident did not consistently receive the restorative care necessary to maintain or improve functional abilities as recommended by therapy.