Failure to Provide Ordered Restorative Walking Services
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered restorative walking services to a resident with multiple chronic conditions, including COPD, hypertensive heart disease, type 2 diabetes, chronic venous ulcers to both lower extremities, PVD, a history of falls, and heart disease. The resident was observed seated in a wheelchair with a rolling walker present in his room and later in the activity room. He reported that his therapy had been discontinued due to insurance coverage and that, although he has a walker, he only walks sometimes by himself because staff do not offer to walk with him. Nursing staff, including an RN, stated that the resident is alert, oriented, compliant with care, and has a walker, but they had not seen him walk often and were unsure when or how often restorative staff work with residents. The Restorative Nurse reported that residents are assessed on admission and quarterly for restorative services, and that when therapy is discontinued, recommendations and goals are to be continued in a restorative program carried out by unit managers and floor CNAs. She stated that the resident should be on a walk-to-dine program but was unaware he was not receiving those services and was not aware of any pattern of refusals, despite noting there were many refusals documented. A CNA reported not knowing who performs restorative services and stated that floor CNAs do not do them. The resident’s restorative nursing assessment documented that he was on a restorative walking program and should walk to and from the dining room with a rolling walker and wheelchair follow, and his care plan indicated he requires assistance with ambulation. However, the Nursing Rehab Walking report showed that on 11 of 14 days reviewed he did not receive restorative walking services, and the care plan did not document refusals prior to the survey date, contrary to the facility’s Restorative Nursing Program policy that individualized programs be reflected on the care plan and consistently carried out by staff.
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