Failure to Notify Physician of Resident's Repeated Refusal of ROM Therapy
Penalty
Summary
The facility failed to notify the physician and resident representative when a resident with severe cognitive impairment and multiple physical disabilities refused prescribed range of motion (ROM) therapy over several consecutive days. The resident, who was dependent on staff for all activities of daily living and had a history of stroke, hemiplegia, and contractures, was documented as refusing ROM exercises for eight consecutive days. Despite facility policy requiring physician notification after two or more consecutive refusals, there was no documentation of such notification in the clinical record. Interviews with facility staff, including an LVN and the DON, confirmed that neither the physician nor the family had been informed of the resident's ongoing refusal of therapy, as required by both the care plan and facility policy. The lack of timely notification resulted in delayed continuity of care for the resident, who was observed to be nonverbal and immobile in bed during the survey period.