F0688

E

Failure to Provide and Accurately Document Ordered Splint Therapy for Contractures

Humble, Texas Survey Completed on 01-28-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide ordered splint therapy and appropriate services to maintain or improve range of motion (ROM) for a resident with significant contractures and hemiplegia. The resident, an older male admitted with diagnoses including cerebral infarction, left knee contracture, hemiplegia of the left nondominant side, and cognitive communication deficit, had a quarterly MDS showing moderate cognitive impairment and impaired ROM in upper and lower extremities on one side. His care plan identified altered musculoskeletal status related to contractures of the left hand and left knee, with interventions to encourage, supervise, and assist with use of supportive devices (splints) as recommended, and to monitor the left hand and left knee splint/carrot daily and wear as tolerated.

Physician orders directed that a left knee splint be donned and doffed every day shift for up to 4 hours daily or as tolerated, and that a left hand orthotic be applied daily for 4 hours or as tolerated, with monitoring for skin issues. The MAR for January documented that both the left knee splint and left hand orthotic were administered every day from the 1st through the 27th, with repeated entries by one LVN indicating they were applied. However, on the survey date, observations showed the resident lying on his right side with contracted lower extremities and no leg splint in place, and later observation confirmed there was no splint on his left hand. The resident’s family member reported that his legs were restricted from the knee and that this was not his condition on admission, and stated that staff did not rotate him.

Interviews with staff revealed that the ordered splints were not being consistently applied despite documentation indicating otherwise. The Director of Rehabilitation reported that PT had previously worked on passive ROM and issued a left knee splint, and OT had supplied a left-hand carrot, but therapy services had ended months earlier. One LVN stated he was responsible for applying the splints on day shift, acknowledged he had not seen the hand splint for weeks and could not find it after a room change, and estimated he had not applied the leg splint since the prior year. He admitted sometimes forgetting the splints and confirmed he had signed in the computer that the splints were applied when they were not. Other staff, including another LVN and CNAs, either could not recall the last time they applied the splints or reported they had not seen the splints in use recently. The facility’s policy on immobilization devices and splints required review of physician orders and documentation of all care and the resident’s response, which was not followed in practice for this resident’s splint use.