Failure to Maintain or Improve Range of Motion and Mobility
Penalty
Summary
The facility failed to provide appropriate care and services to maintain or improve range of motion (ROM) and mobility for three residents with identified ROM and mobility concerns. For one resident with a history of muscle weakness, diabetes, peripheral vascular disease, and difficulty walking, the facility did not provide a physical therapy screening or evaluation after a decline in the ability to perform sit-to-stand transfers was identified. The resident's restorative nursing aide (RNA) program for sit-to-stand transfers was discontinued without a therapy evaluation, and no interventions were implemented to address the decline, despite facility policy requiring such actions. The resident did not receive a right-hand splint to prevent further ROM decline, even though significant limitations and contractures were observed and confirmed by occupational therapy. Additionally, the facility did not provide active assistive range of motion (AAROM) exercises to both arms and legs as ordered by the physician on a specified date. The report also documents that the facility did not accurately assess another resident's right hand during a joint mobility evaluation and failed to provide passive range of motion (PROM) exercises to both wrists during an RNA session, as ordered by the physician. For a third resident, the facility did not provide ROM exercises to both wrists, hands, and ankles during an RNA session, again failing to follow physician orders. These failures were identified through record reviews, staff and resident interviews, and direct observations of care sessions, which revealed inconsistencies between ordered care and care provided. As a result of these failures, one resident lost the ability to stand and experienced frustration and feelings of debilitation. The lack of appropriate interventions and assessments also created the potential for further ROM decline in the affected residents. The facility did not complete required interdisciplinary team (IDT) care plan reviews or document discussions regarding the residents' declines in mobility, and there was no evidence that therapy evaluations were requested or conducted when declines were identified.