Failure to Provide Consistent Restorative Nursing Program for Residents at Risk for ROM Decline
Penalty
Summary
Surveyors identified that the facility failed to ensure an ongoing restorative nursing program was completed according to the care planned needs for all twelve sampled residents at risk for a decline in range of motion (ROM). Observations, interviews, and record reviews revealed that restorative programs were not consistently provided as ordered or care planned. For example, one resident expressed a desire for daily restorative exercises and noted that his program was only completed once a week, with significant gaps in documentation and actual provision of services. The restorative aide confirmed that she was frequently reassigned to CNA duties, resulting in missed restorative sessions for residents. Review of electronic medical records (EMRs) for all twelve residents showed inconsistent and infrequent documentation of restorative care. Many days were marked as 'Not Applicable' for the provision of ROM exercises, and in several cases, there were only a handful of days within a 30-day period where restorative interventions were documented as completed. Some residents were noted as 'Not Available' or 'Refused,' but the majority of days lacked any indication that restorative care was attempted or provided, despite care plans and referral forms specifying the frequency and type of interventions required. Interviews with residents and staff further corroborated the lack of consistent restorative care. While some residents reported satisfaction with the program, others, including family members, questioned the adequacy of services, especially in relation to discharge planning and maintenance of function. Staff interviews revealed that the restorative aide's frequent reassignment to CNA duties directly impacted the ability to deliver restorative programs as scheduled. The facility's own documentation and staff statements confirmed that the restorative nursing program was not implemented as care planned for residents at risk for ROM decline.