Failure to Provide Contracture Management for Resident with Limited ROM
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent a decrease in range of motion (ROM) for a resident with documented contractures. The resident, who had a history of intracranial injury, spastic hemiplegia, and contractures affecting both the right hand and neck, was observed multiple times without any splint, hand roll, or positioning device in place for his contractures. The care plan for the resident did not include individualized interventions for contracture management of the right hand or address the neck contracture, despite clear evidence of these conditions. Staff interviews revealed a lack of awareness and guidance regarding the management of the resident's contractures. A CNA reported that devices previously used for the resident's neck and hand were no longer available, and she was unsure whether to use alternatives like a rolled-up washcloth due to the absence of specific orders. The MDS Coordinator acknowledged that the care plan contained only basic interventions and did not address the resident's specific contracture needs, particularly for the neck, which she had not considered a contracture. Therapy staff confirmed that the resident had not received therapy for his contractures since the previous year, and the occupational therapy discharge summary had recommended the use of a palmar guard for the right hand. Facility policy required assessment and appropriate treatment for loss of voluntary movement and limitation in ROM, including the neck, but these were not implemented for the resident. Observations consistently showed the resident without necessary devices to manage his contractures, indicating a failure to follow policy and provide individualized care.