Failure to Provide Range of Motion Exercises as Outlined in Care Plan
Penalty
Summary
A deficiency was identified when a resident with significant medical conditions, including chronic respiratory failure, quadriplegia, and dependence on a ventilator, did not receive appropriate range of motion (ROM) exercises as outlined in their care plan. The resident was assessed as having upper and lower extremity impairments on both sides and was dependent for all activities of daily living. The care plan and CNA care card both specified that staff should assist the resident with upper and lower body ROM exercises during personal care and encourage participation as able. During two separate personal care observations, surveyors noted that staff performed hygiene and positioning tasks but did not carry out or offer ROM exercises to the resident, nor did they ask the resident about performing ROM. Staff were observed washing, repositioning, and dressing the resident, but there was no evidence of joint movement exercises being performed as required by the care plan. The resident confirmed that staff did not ask about or perform ROM during care. Interviews with staff revealed uncertainty regarding the specific expectations for ROM exercises, including the number of repetitions and which residents required them. While staff acknowledged that ROM instructions would be found on care cards, they were either unsure of the details or deferred to therapy or nursing leadership for clarification. The lack of ROM provision was directly observed and confirmed through staff and resident interviews, indicating a failure to follow the established care plan and facility policy for maintaining or improving the resident's range of motion.