Failure to Provide Ordered Restorative Nursing Ambulation Services
Penalty
Summary
The deficiency involves the facility’s failure to provide restorative nursing assistant (RNA) services as ordered for a resident with limited range of motion and mobility needs. The resident was admitted with bilateral primary osteoarthritis of the hip and a right artificial knee joint, and an MDS dated 9/11/2025 showed the resident had intact cognition and required varying levels of assistance with ADLs, including substantial/maximal assistance for showering and partial/moderate assistance for lower body dressing and footwear. A physician’s order dated 12/15/2025 directed that the resident receive RNA ambulation services daily, three times per week, for 60 feet with a front-wheeled walker and gait belt as tolerated. Review of RNA documentation for December 2025 and January 2026, along with interviews with RNA staff and the Director of Staff Development (DSD), showed that RNA services were not provided or documented on 12/22/2025, 12/26/2025, and 1/2/2026. During observation and interview, the resident reported that RNA sessions were supposed to occur three times per week but that staff did not come as scheduled. The RNA log and documentation reviewed with the DSD confirmed that the resident received only one RNA session during the week of 12/22/2025–12/28/2025 and two sessions during the week of 12/29/2025–1/4/2026, instead of the ordered frequency. The DSD stated that if RNA services were not documented, they were not done, and acknowledged that RNA services should be consistently provided as scheduled to maintain functional mobility and prevent decline. The DON stated that RNA services are important to help maintain residents’ mobility and that inconsistent provision could potentially cause a decline, and further stated that the resident did not have a care plan for RNA services, which should have been in place to guide staff. Review of the facility’s Restorative Nursing Services policy indicated that restorative goals and objectives are individualized, resident-centered, and outlined in the resident’s plan of care, which was not done in this case.
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