Failure to Provide Ordered Restorative ROM Services
Penalty
Summary
Failure to provide appropriate restorative nursing services to maintain or improve range of motion (ROM) occurred when a resident on an active ROM program did not consistently receive ordered exercises. The resident, who was cognitively intact and diagnosed with adult failure to thrive, lack of coordination, reduced mobility, heart failure, COPD, and morbid obesity, reported preferring to remain in bed but wanting staff assistance with ROM and strengthening exercises to maintain existing strength. The resident stated staff did not ask him to participate in any restorative ROM programs. The resident’s care plan documented limited physical mobility, a need for staff assistance with bed mobility, transfers, hygiene, and dressing, and directed staff to provide supportive care and gentle ROM as tolerated. The care plan also specified a Restorative Nursing Active ROM Program with bilateral lower-extremity ROM exercises for 10 repetitions, twice daily. Restorative program documentation for three consecutive months showed multiple gaps, with over 20 missing entries where there was no indication that restorative exercises were attempted or completed, and multiple entries listing the resident as unavailable. The DON confirmed the resident was always in his room and consistently available for the restorative program, stated the program could be done in bed and should be offered multiple times per day, and acknowledged that the restorative aide “doesn’t really do his job” and that the current census required more than one restorative aide to provide effective services.
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