Failure to Provide Appropriate ROM and Contracture Management
Penalty
Summary
The facility failed to provide appropriate care and services to maintain or improve range of motion (ROM) and contracture management for two residents with limited ROM. For one resident with a history of cerebral infarction, hemiplegia, and limited mobility, there was a lack of clear physician orders specifying the schedule, duration, and responsible staff for donning and doffing a left hand brace. Observations showed the resident was not consistently wearing the brace, and staff interviews revealed uncertainty about who should apply the brace and when. The care plan only referenced the brace in the context of skin integrity, and there was no documentation of skin monitoring under the brace prior to the survey. Occupational therapy notes indicated the need for the brace, but the facility did not have corresponding physician orders or consistent documentation of its application and monitoring. For another resident with severe cognitive impairment, dementia, and a left hand contracture, the facility failed to follow physician orders for contracture management. The resident was observed without the prescribed adaptive equipment, such as a two-handled cup, and there was no care plan intervention for the use of a carrot splint for the contracture. Staff interviews confirmed that the resident often refused the splint, but there was no documentation of splint application or refusals in the medical record. The physician's order for the splint lacked specific parameters, and the care plan did not address the use or effectiveness of the splint or the resident's refusals. Additionally, the facility's documentation systems, including the medication and treatment administration records and CNA task documentation, did not reflect the application of splints or adaptive equipment as ordered. Staff were unclear about the frequency and responsibility for applying the splints, and the care plans were not updated to include these interventions or to monitor their effectiveness. These deficiencies resulted in a lack of appropriate treatment and services for residents with limited ROM and contractures, as required by facility policy and physician orders.