Failure to Provide Required Rehabilitation Services per Care Plan
Penalty
Summary
The facility failed to provide required rehabilitation services to a resident who was admitted following a hospital stay for a stroke and sacral pressure ulcer. The hospital discharge summary recommended continued physical and occupational therapy due to the resident's significant mobility and activities of daily living (ADL) limitations. Upon admission, physician orders were in place for speech, occupational, and physical therapy evaluations and treatment as indicated. However, the therapy screening form was not fully completed, and therapy services were not initiated. The justification for not evaluating the resident was the absence of a PRAFO boot, which the facility was in the process of obtaining, despite there being no physician order for the device. The resident did not receive any occupational, physical, or speech therapy services after admission, despite being cognitively intact, expressing a desire to participate in therapy, and having no documented refusal of care. Interviews with staff revealed a lack of clarity regarding the resident's therapy status. The Therapy Director stated that therapy was withheld because the resident required total assistance and a PRAFO boot was needed, which the resident was expected to partially pay for. The Therapy Director also indicated that therapy services would not begin until the PRAFO boot was obtained, and was unable to explain why upper body therapy could not proceed in the meantime. Further interviews with the Nurse Practitioner and Administrator revealed that there was no physician order for the PRAFO boot and that it was not required for therapy participation. The Administrator was unaware that the resident had been asked to pay for the device and stated that the facility preferred insurance or the resident to cover the cost. Despite clear recommendations and orders for therapy, the resident did not receive the necessary rehabilitative services as required by her care plan.