F0688

D

Failure to Provide ROM Interventions and Implement Hand Splint Orders

Granger, Iowa Survey Completed on 02-26-2026

Penalty

No penalty information released

Summary

Surveyors identified a deficiency in the facility’s failure to provide services and treatment to maintain or improve range of motion (ROM) and prevent further decline for residents with contractures. Resident #40 had a history of stroke with left-sided hemiplegia and documented functional limitations in ROM of the left upper and lower extremities. Her care plan problem for history of CVA with left-sided weakness included goals to prevent complications such as contractures, but listed only general interventions such as administering medications, allowing time to communicate, and therapy as ordered, without specific interventions for her left hand contracture. Observations showed her left hand was tightly closed with fingers curled into the palm, no padding or device in place, and visible indentations in the palm from fingernails.

Resident #40 reported she could not open her left hand due to contracture, did not receive therapy for the contracture, and that the facility did not provide anything to keep her hand open or prevent her fingernails from digging into her skin. She stated she sometimes placed Kleenex in her palm herself for relief. A review of her EHR revealed no orders or interventions addressing the left hand contracture. The ARNP confirmed the resident had a left hand contracture, stated she had recommended a splint but believed insurance would not pay, and acknowledged there was no order for a washcloth or foam block despite having discussed these options with the resident. The OT reported he was only working with the resident on power wheelchair safety and had not evaluated or treated her hand contracture or assessed her for a splint.

Resident #44 also had a history of stroke with hemiplegia and documented ROM impairment on one side. Observation showed the four fingers of her left hand curled into the palm with the thumb extended and no padding between the fingers and palm. She reported having contractures from strokes, being unable to open her fingers independently, sometimes using gauze under her fingers, not receiving restorative exercises for her hand, and not having a splint, stating she was not able to receive therapy due to insurance. Her orders included a physician’s order for her to be fitted for and receive a left hand splint for contracted fingers, but the ARNP and OT stated that insurance would not cover a splint or evaluation, and the OT had not completed an evaluation or provided treatment. The DON was unsure what had been done since the splint order was received or what else had been done to prevent further contracture, despite a facility policy stating that residents with ROM limitations would be referred to therapy for focused assessment and that the facility would provide appropriate interventions, exercises, therapy, and equipment such as braces or splints.