Failure to Assess and Address Resident's Contracted Hand and Wheelchair Fit
Penalty
Summary
The facility failed to identify and assess a resident's contracted left hand and did not ensure the resident's wheelchair was appropriately fitted for comfort and mobility. The resident reported discomfort and inability to self-propel in the high back wheelchair provided, stating he was not informed of the reason for the change and often became stuck in the hallway. Observations confirmed the resident's left hand was contracted, with fingernails pressing into the palm, and the resident recalled previously using a ball to help with his hand. Staff interviews revealed that a splint or ball was not currently in use, and there was no referral for a brace. The physical therapy assistant acknowledged the resident did not fit properly in the high back wheelchair, which caused his knees to bend up and did not provide adequate trunk support, further limiting his mobility. Review of the resident's records showed a history of neurological conditions, including epilepsy, transient ischemic attacks, and type 2 diabetes. The Minimum Data Set indicated a one-sided functional limitation in range of motion, but therapy discharge summaries and the current care plan did not address the contracted hand or the use of the high back wheelchair. The DON stated that the facility had only an informal restorative program, with no dedicated restorative nurse for the past five weeks, and was unaware of the resident's issues with the wheelchair and contracted hand until recently. The lack of assessment and care planning for the resident's range of motion and mobility needs led to the deficiency.