Failure to Provide Timely ROM Assessments and Daily PROM Services
Penalty
Summary
The facility failed to provide appropriate services to prevent a decline in joint range of motion (ROM) for two residents with limited ROM. For one resident with diagnoses including bipolar disorder, dementia, and mobility abnormalities, the facility did not complete timely quarterly Joint Mobility Screenings/Assessments as required. The last assessment was completed at admission, and subsequent quarterly screenings were missed, which are necessary to monitor changes in ROM and determine if therapy services are needed. This omission was confirmed by both the Minimum Data Set Nurse and the Director of Rehab, who acknowledged that the screenings were not performed according to schedule. For another resident with diagnoses including dysphagia, seizures, and hemiplegia, the facility failed to ensure that passive range of motion (PROM) exercises were provided daily as ordered by the physician. Review of the RNA task forms showed that PROM was not performed every day, despite a physician's order for daily exercises. Both the Licensed Vocational Nurse and the Restorative Nurse Assistant confirmed that PROM was not completed as required, and acknowledged the importance of these exercises in preventing contractures and maintaining function. Facility policies and procedures reviewed indicated that residents with limited ROM should receive regular assessments and services to prevent further decline. The job description for the Restorative Nurse Assistant also specified the responsibility to assist residents with ROM exercises as ordered. The failure to follow these protocols resulted in missed opportunities to monitor and maintain the residents' joint mobility.