Failure to Provide Contracture Management Devices and Interventions for Residents with Limited Range of Motion
Penalty
Summary
The facility failed to provide appropriate care and services to maintain or improve range of motion (ROM) for two residents with limited ROM. For one resident, who had a history of cerebral palsy, contractures, and severe cognitive impairment, the care plan and physician's orders specified the use of a left palm protector to address a left hand contracture. Despite these orders and documentation indicating the device should be applied five times per week, multiple observations over several days revealed that the palm protector was not in place. Interviews with CNAs confirmed that they did not apply any device to the resident's hand to prevent further contracture, and the restorative nursing program for this intervention had only recently been initiated. For another resident with a history of CVA, apraxia, and severe cognitive deficit, the care plan included passive and active ROM exercises to prevent contractures, but there was no evidence of an occupational therapy program or physician's orders for a contracture management device. Observations showed the resident had a right hand contracture with no assistive device in place. The facility's contracture prevention policy required risk assessment, care planning, and implementation of prevention programs, but these steps were not fully carried out for this resident. Interviews with facility staff, including the DON and DOR, revealed a lack of consistent monitoring and implementation of contracture management interventions. The DON acknowledged that not utilizing a palm protector could increase contractures and that a device for the second resident had been requested but not obtained. The failures in applying and monitoring prescribed devices and interventions contributed to the deficiency in providing appropriate care for residents with limited ROM.