Failure to Provide Consistent Range of Motion Care and Use of Palm Protector
Penalty
Summary
The facility failed to ensure that range of motion (ROM) exercises and the use of a palm protector were consistently provided for two residents with limited ROM. One resident with severe cognitive impairment, hemiplegia, Parkinson’s disease, and contractures was dependent on staff for all activities of daily living and had clear care plan and physician orders for daily passive ROM and continuous use of a palmar hand guard. Despite these orders, observations revealed that the resident was often without the palm protector, and staff interviews confirmed that the device had not been seen or used for extended periods. Staff also failed to perform or document ROM during multiple care opportunities, and the resident’s care records indicated no restorative nursing minutes for ROM or splint/brace assistance. Staff were aware of the need for the palm protector and ROM but did not consistently implement these interventions, and the palm protector was found unused in a drawer during care observations. Another resident with a history of stroke, contractures, and impaired mobility was also not provided with a ROM program despite documented impairments and care plan interventions indicating the need for ROM to prevent further contracture. The resident’s care sheets and physician orders lacked any mention of a ROM program, and therapy evaluations over several years did not recommend or initiate a ROM program, nor did they document refusals until a recent assessment. Interviews with staff revealed a lack of awareness and documentation regarding the resident’s need for ROM, and the care plan lacked specific interventions or instructions for ROM. The resident expressed a desire for help with hand movement and did not have a splint or brace in place during observations. Throughout the review, staff interviews indicated reliance on care plans and task sheets to guide care, but these documents were incomplete or missing necessary instructions for ROM. There was also a lack of clear policy or standardized approach for ROM programs, with the facility stating that each program was individualized and based on therapy recommendations. The absence of consistent documentation, implementation, and monitoring of ROM interventions for residents with limited mobility led to the identified deficiencies.