Failure to Provide and Evaluate Restorative Nursing Programs
Penalty
Summary
The facility failed to provide care-planned restorative interventions and conduct periodic evaluations of current restorative programs for two out of three sampled residents reviewed for restorative services. For one resident with quadriplegia who was bed bound and required total assistance with activities of daily living, the care plan included a splinting and range of motion (ROM) program to prevent contractures. However, documentation showed that the passive ROM and splinting programs were not consistently offered on multiple dates, and the resident reported that staff did not have time to do exercises with them. Additionally, there was confusion among staff regarding responsibility for applying the splint, and therapy had indicated that it was the nursing assistants' responsibility to carry out the program. Another resident with dementia and muscle weakness, who required assistance with ambulation, was not consistently offered their care-planned ambulation program on several dates. Observations confirmed that the resident was not offered ambulation to or from meal service, despite documentation indicating refusals. Staff interviews revealed challenges in completing restorative programs due to staffing shortages and noted that refusals were documented, but the restorative program was not being well followed. A third resident, who had chronic obstructive lung disease, neuralgia, and depression, and required total assistance for most activities of daily living, did not have any restorative interventions included in their care plan to help achieve goals related to improving mobility and self-care. Staff interviews indicated that this resident would benefit from a restorative program, but such a program was not in place due to lack of staff. The facility's failure to provide and assess restorative services as care-planned placed residents at risk for a decline in mobility and decreased quality of life.