Failure to Provide Contracture Management and Range of Motion Services
Penalty
Summary
The facility failed to provide appropriate treatment and services to prevent further decreases in range of motion for a resident with hemiplegia and existing contractures in the fingers of one hand. The resident's care plan and physician orders specified the use of a contracture pillow or a rolled washcloth during the day to manage contractures, but observations over several days revealed that these interventions were not consistently implemented. The resident was repeatedly observed without the prescribed contracture pillow or rolled washcloth in place, and staff interviews confirmed that these items were often overlooked or not provided as ordered. Further, there was no evidence in the clinical record of comprehensive assessment, ongoing monitoring, or range of motion (RA) exercises being completed for the resident. Multiple staff members, including CNAs, LPNs, and therapy staff, indicated confusion or lack of knowledge regarding responsibility for implementing the contracture interventions. Some staff stated that RA services were not being provided, and others were unaware of the resident's needs or the existence of a contracture pillow. The designated staff member responsible for RA was on leave, and no alternative arrangements were made, resulting in a lack of consistent care to address the resident's contractures.