Failure to Provide Ordered Restorative Nursing Services
Penalty
Summary
The facility failed to provide restorative nursing assistant (RNA) services as ordered by physicians for multiple residents with impaired range of motion (ROM) and mobility. Physician orders and care plans for several residents required specific RNA interventions, such as passive or active-assisted ROM exercises, application of orthotic devices, and ambulation assistance, to be performed five times a week or as tolerated. Documentation revealed that these services were not consistently provided according to the orders, with several days missed for each resident. There was no documented evidence explaining the missed RNA services or any clinical justification for not following the prescribed interventions. For example, one resident with impaired ROM in all extremities and a care plan to maintain current ROM functions did not receive the required frequency of PROM exercises and orthotic device applications. Another resident with bilateral hand contractures and impaired ROM was not provided with hand rolls and PROM exercises as ordered. Additional residents with limited mobility, functional quadriplegia, or other impairments also missed multiple RNA sessions, despite clear physician orders and care plan interventions specifying the frequency and type of restorative care needed. Interviews with staff, including RNAs, RNs, and the DON, confirmed that RNA services were not provided as ordered due to staffing shortages and the reassignment of RNAs to CNA duties. Staff acknowledged the missed services and verified that documentation did not reflect the required frequency of RNA interventions. The facility's policy on restorative nursing services required individualized, resident-centered care as outlined in each resident's plan, but this was not followed for the residents reviewed.