Failure to Provide Restorative Nursing Services Due to Insufficient Staffing
Penalty
Summary
The facility failed to provide sufficient qualified nursing staff to deliver restorative nursing services to residents with limited range of motion. Specifically, two residents who were cognitively impaired and dependent on staff for activities of daily living were not provided with restorative nursing programs, despite being identified as at risk for further decline in function and mobility. Occupational and physical therapy evaluations and discharge summaries documented that these residents would have benefited from restorative services, and referrals were made for such programs. However, the restorative nursing programs were never implemented, and there was no documentation showing that the recommended interventions, such as passive range of motion exercises and splint and brace programs, were initiated. Interviews with facility staff, including the Director of Rehabilitation, Administrator, and Director of Nursing, confirmed that the lack of restorative nursing services was due to insufficient and unqualified staff. The therapy department acknowledged that residents who were at risk for declines in range of motion and contracture formation were not referred for restorative programs because there were not enough staff to provide these services. As a result, the residents did not receive the restorative care recommended by therapy, and the facility did not meet the regulatory requirement to provide adequate nursing staff to meet the needs of every resident.