Failure to Provide Contracture Management and ROM Care
Penalty
Summary
The facility failed to provide appropriate care and treatment to manage contractures for a resident with severe joint immobility in both ankles. Observations showed the resident lying in bed with both feet extended downward, wearing only soft foam heel pads to protect against skin breakdown. Interviews with staff revealed that no range of motion (ROM) exercises or contracture management devices were provided, as there was no physician order for such interventions. The restorative nursing assistant confirmed that the resident, who had a history of cerebral infarction and severe joint immobility, was not included in the restorative nursing program for ROM exercises, despite previous physical therapy discharge instructions recommending continued ROM care. Record reviews indicated that the resident had documented contractures and impairment in both lower extremities, with multiple assessments and physician notes confirming the condition. The licensed nurse and physical therapist both acknowledged that the resident should have been referred for therapy and provided with appropriate devices to prevent further contracture and foot drop. Facility policies required treatment and services for residents with limited ROM, including proper positioning, body alignment, and passive ROM exercises, but these were not implemented for this resident.