Failure to Timely Update Care Plan for Restorative Device Use
Penalty
Summary
The facility failed to follow its policy and procedures regarding the development and revision of a comprehensive care plan for a resident requiring restorative care. Specifically, a resident who had been admitted almost two years prior and was listed on the facility's splints/brace/prosthetic log did not have the use of splints, braces, or prosthetics included in their comprehensive care plan as of the care plan received on 9/16/25. Observations revealed the resident's hands were severely contracted and splints were not in use at the time. When questioned, the resident confirmed use of hand splints, and the restorative nurse later stated the resident had a left palm protector. However, review of the electronic medical record showed that the splint program was not added to the care plan until 9/16/25, despite the resident's ongoing need. The facility's policy requires that person-centered care plans, including restorative devices, be developed and periodically reviewed within 7 days of the comprehensive assessment, but this was not done for the resident in question.