Failure to Provide Ordered Physical Therapy Services During Therapist Leave
Penalty
Summary
The facility failed to ensure continuity of ordered physical therapy (PT) services for a resident with significant mobility and functional limitations, including radiculopathy, spinal stenosis, and a recent lumbosacral spinal fusion. The resident was admitted with orders for skilled PT five times per week for four weeks, with specific goals and interventions outlined in the physician's plan of care. Documentation showed that after the facility's physical therapist went on leave, PT services were not provided for 12 calendar days (8 business days), despite no modifications, discontinuation, or suspension of the physician's orders during this period. Interviews with facility staff, including the Director of Rehabilitation and the Regional Director of Clinical Nursing Services, confirmed that PT services were interrupted due to the therapist's leave and that efforts to secure a replacement were ongoing during the lapse. There was no documentation that residents or their representatives were formally notified of the interruption, nor were care plans or physician orders updated to reflect the change in services. The facility's assessment indicated that they provide rehabilitative services to meet resident needs, but during this period, the ordered PT services were not delivered as required.