Failure to Provide Consistent Restorative Nursing Programs Due to Insufficient Staffing
Penalty
Summary
The facility failed to provide sufficient nursing staff to consistently deliver restorative nursing programs as ordered for residents requiring these services. Three residents reviewed for restorative services did not receive their prescribed programs at the frequency and duration specified in their care plans. For example, one resident with a history of cerebrovascular disease, diabetes, and generalized weakness was supposed to participate in a daily ambulation program but only received the service once in a 30-day period. The lack of consistent restorative care was confirmed by both staff and documentation, with staff citing insufficient time and staffing to complete these programs as ordered. Another resident with hemiplegia, diabetes, and other chronic conditions was on a restorative ambulation program intended to be provided daily, six to seven times per week. However, records showed the program was inconsistently offered, with some weeks showing only three to five sessions and other weeks with no documentation of the program being offered or completed. The Director of Nursing acknowledged that the records did not reflect the program being provided according to the care plan. A third resident, also with hemiplegia and multiple comorbidities, was prescribed a daily passive range of motion (PROM) program for the affected upper extremity. Documentation revealed the program was delivered only four to five times per week, rather than the ordered six to seven times. The Director of Nursing confirmed that the program was not provided at the required frequency. In total, the facility had identified 41 residents with orders for one or more restorative programs, indicating a broader issue with staffing and program delivery.