Failure to Provide Ordered Rehabilitative Evaluations
Penalty
Summary
The facility failed to provide specialized rehabilitative services as required by physician's orders for two residents. For one resident with diagnoses including aphasia, cerebral infarction, dysphagia, and contractures, there were physician's orders for physical therapy (PT), occupational therapy (OT), and speech therapy (ST) evaluations. Despite these orders, the resident did not receive the required evaluations. The Director of Rehabilitation (DOR) confirmed that the evaluations were not conducted and could not provide a reason for the omission, acknowledging that the orders should have been followed. Another resident, admitted with Parkinson's disease, diaphragmatic hernia, and lack of coordination, had a physician's order for a speech therapy evaluation. Instead of a formal evaluation, the speech therapist performed a limited, hands-off rehab screen and determined that a full evaluation was not needed. Both the speech therapist and the DOR confirmed that the facility's practice was to conduct a rehab screen first, regardless of the physician's order for a formal evaluation, and only proceed with a full evaluation if the screen indicated a need. This practice resulted in the resident not receiving the ordered ST evaluation. Observations and interviews with both residents revealed significant functional limitations, including impaired cognition, limited range of motion, and difficulties with activities of daily living. Facility policy and job descriptions reviewed indicated that therapy services were to be provided upon written physician order and that therapists were responsible for promptly evaluating patients upon receiving such referrals. Despite these policies, the required evaluations were not completed as ordered for the two residents.