Failure to Provide Hand Roll for Resident with Limited ROM
Penalty
Summary
A deficiency was identified when a resident with a history of left forearm contracture, cerebrovascular accident, and hypertension did not receive appropriate services to prevent further decline in joint range of motion (ROM). The resident's records indicated severe joint mobility limitation in the left hand and fingers, and assessments showed the need for maximal assistance with daily activities. Despite these findings, the resident was observed without any adaptive equipment, such as a hand roll, in place to prevent further contracture of the left hand. Interviews with facility staff revealed that the need for a hand roll had been reported by the Restorative Nursing Assistant to the Director of Rehab a month prior, but no action was taken to implement this intervention. The Director of Rehab acknowledged the oversight and confirmed that the resident would benefit from a hand roll to prevent further contractures. Facility policies reviewed indicated a commitment to providing restorative nursing care and preventing hand contractures, but these were not followed in this case.