Failure to Provide Ordered Range of Motion Services
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent further decline in range of motion for three residents who required Restorative Nursing Assistant (RNA) services as indicated in their physician orders and care plans. Specifically, one resident with hemiplegia and hemiparesis following a cerebral infarction, and another resident in a persistent vegetative state with contractures, both had active physician orders and care plans for RNA programs three times a week for upper and lower extremities. However, documentation and staff interviews revealed that these residents only received one or two sessions per week instead of the prescribed three sessions. Observations confirmed that both residents were dependent on ventilators and feeding tubes, with one resident exhibiting stiffness in the upper extremities. The RNA responsible for providing these services stated that she was unable to consistently deliver the RNA program due to being reassigned as a CNA during staff shortages. Facility policy required verification of physician orders and review of care plans for range of motion exercises, but these were not consistently followed, resulting in a failure to provide the ordered frequency of care.