Failure to Provide Consistent Restorative Care and Follow Therapy Recommendations
Penalty
Summary
The facility failed to provide appropriate restorative care and follow therapy recommendations for four residents with limited range of motion (ROM) and mobility impairments. Documentation and care plans indicated that residents with conditions such as multiple sclerosis, hemiplegia, arthritis, and spinal stenosis were to receive specific restorative nursing programs (RNP), including passive and active ROM exercises, ambulation, and use of exercise equipment. However, records showed inconsistent or missing documentation of these interventions, with many days left blank or marked as not applicable, and progress notes often stating that residents did not participate in RNPs during the review periods. Observations and interviews with residents revealed that some residents expressed a desire to participate in restorative activities, such as walking or using exercise equipment, but were unable to do so due to lack of staff availability or supervision. Residents reported waiting for staff assistance to perform exercises or use equipment, and in some cases, only received restorative interventions a few times per month despite care plan directives for more frequent activity. Staff interviews confirmed that there was no designated restorative aide, and that CNAs were expected to perform restorative activities as part of their regular duties, but often could not due to staffing shortages and competing responsibilities. Further interviews with facility leadership and therapy staff indicated a lack of clear assignment and accountability for restorative care. Therapy staff expected nursing to follow through on therapy discharge recommendations, but nursing staff reported that restorative programs were not consistently implemented or documented. The facility's policy required individualized restorative plans and monthly summaries, but these were not consistently in place or up to date. The absence of a dedicated restorative aide and reliance on CNAs to perform restorative care contributed to the inconsistent delivery and documentation of required interventions for residents with limited ROM and mobility needs.