Failure to Provide Restorative Nursing Services as Ordered and Care Planned
Penalty
Summary
The facility failed to provide restorative nursing services (RNS) as ordered and care planned for four residents who required therapy to maintain or improve range of motion, mobility, and strength. For one resident with diagnoses including malignant neoplasm of the prostate, chronic kidney disease, dementia, and a history of falls, the care plan and physician orders specified RNS for ambulation up to six times a week. However, there was no evidence in the medical record that these services were completed. Staff interviews revealed that restorative therapy was not consistently provided, with one CNA stating she was unable to complete therapy when assigned to other duties, and the Director of Clinical Services indicating the resident was not on a restorative program at the time. Another resident with malignant neoplasm of the stomach and diabetes required maximum assistance for ambulation and was care planned to receive RNS for ambulation and strengthening exercises with ankle weights. Facility records showed that this resident did not receive therapy for ambulation or strengthening in one month, received minimal therapy the following month, and did not receive strengthening therapy in the subsequent month. Both the resident and a family member confirmed that therapy, including the use of weights, had not been provided for weeks. Two additional residents with hemiplegia and hemiparesis following cerebral infarction were also affected. Their care plans included RNS for range of motion, strengthening, and transfer exercises with ankle weights, to be provided six to seven times a week. Facility flow records indicated significant gaps in the provision of these services, with some months showing only one or a few sessions and other months with no therapy documented. Interviews with these residents confirmed that restorative therapy was not being provided as planned. Facility administrators acknowledged the lack of evidence to show that restorative therapy was delivered according to the care plans.