Failure to Provide Range of Motion Exercises and Restorative Devices
Penalty
Summary
Surveyors identified that the facility failed to provide appropriate range of motion (ROM) exercises and apply restorative devices for three residents with limited mobility and contractures. One resident with contractures of both hands and quadriplegia was observed without hand protectors or splints in place, despite care plans and physician orders specifying the use of such devices. Staff confirmed that the required splints and palm protectors were not available, and temporary alternatives such as rolled towels were not implemented as directed. The restorative nurse acknowledged the lack of supplies and indicated that the administrator had been informed, but no interim measures were put in place. Another resident with left-sided weakness from a stroke reported that staff had not been providing ROM exercises for the affected limbs, expressing concern about developing contractures. A third resident also complained of not receiving ROM exercises for over two weeks. The restorative aide responsible for these residents stated that one of the residents was not on the current list for ROM exercises and admitted that the list was outdated. The aide also noted being unable to perform ROM exercises for all assigned residents due to time constraints and other duties, such as escorting residents or covering for staff absences. Record reviews for the affected residents showed documented diagnoses of contractures, hemiplegia, muscle weakness, and reduced mobility, with care plans and physician orders specifying the need for restorative interventions, including ROM exercises and the use of assistive devices. Facility policies and job descriptions for restorative staff and CNAs require the provision and documentation of ROM exercises and the use of restorative equipment to maintain or improve residents' mobility. Despite these requirements, the facility did not ensure that restorative care was consistently provided, and necessary devices were not available or used as ordered.