Failure to Provide and Implement Restorative Services for Residents with Limited Range of Motion
Penalty
Summary
The facility failed to provide appropriate services to maintain or improve range of motion (ROM) and mobility for four residents with limited ROM and mobility needs. For one resident with a history of stroke and hemiplegia, the facility did not implement the recommendations from a Joint Mobility Assessment for Restorative Nursing Aide (RNA) services, nor did they develop or implement a care plan addressing the resident's risk for activities of daily living (ADL) decline and stroke diagnosis. This resident was observed to be non-verbal, dependent on staff for all ADLs, and positioned in bed with bent limbs, but had no orders or documentation for PT, OT, or RNA services after initial evaluations were ordered. The Director of Rehabilitation (DOR) confirmed that RNA services were recommended but not provided, and the Minimum Data Set Nurse (MDSN) acknowledged the absence of required care plans for stroke and ADL decline. Another resident with severe cognitive impairment and non-traumatic brain dysfunction was not ordered RNA services, despite requiring moderate assistance for ADLs and bed mobility. The resident was observed in bed and, according to their representative, had not received PT or RNA services and was experiencing decline. The DOR stated that the resident was not placed on RNA services due to age and cognitive limitations, but also acknowledged that these were not valid reasons per facility policy, and that such residents should receive RNA therapy to prevent further decline. A third resident with multiple sclerosis, encephalopathy, and a stage four pressure ulcer had severe joint mobility limitations but was not receiving PT, OT, or RNA services. The DOR stated that ROM exercises were withheld due to the presence of wounds, but the wound specialist confirmed there was no directive to restrict ROM. The DOR admitted that a collaborative plan should have been developed. Additionally, a fourth resident with osteoarthritis and encephalopathy did not have RNA services resumed after readmission from a hospital stay, despite previous orders for ambulation with a walker. The DOR and RNA staff confirmed that RNA services were not restarted, and the DON stated that residents are re-evaluated for services upon readmission, but nursing staff were not responsible for notifying rehabilitation. Facility policies reviewed indicated that residents should receive restorative services as needed to prevent decline in ROM.