Failure to Provide Ordered Daily ROM Program to Resident With Quadriplegia
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered and care-planned range of motion (ROM) services to a resident with significant mobility limitations. The facility’s ADL policy requires that, based on comprehensive assessment and care planning, residents receive necessary care and services to maintain or improve their abilities, with ADL needs communicated via the care plan and CNA Kardex. One resident with quadriplegia C5–C7 incomplete, cognitively intact with a BIMS score of 15, had a physician order for PT evaluation and treatment for ROM and pain/spasticity to the bilateral lower extremities (BLE). PT documentation indicated ROM to the BLE was provided, that the resident tolerated it well with improved comfort, and that a ROM program was posted in the room with updated staff recommendations. The comprehensive care plan and CNA Kardex both specified a daily active assisted ROM program to the BLE, referencing signs in the room that detailed specific leg and foot exercises and required a minimum of five repetitions once daily. Despite these orders and care plan interventions, the resident reported not receiving the prescribed daily ROM exercises to her legs, noting that the exercises decreased her edema and pain. During surveyor interviews, one CNA stated that staff use the CNA Kardex to determine resident care needs and acknowledged that the resident had a ROM program with exercises to be done in bed, but confirmed that ROM exercises were not performed that day while assisting with the resident’s care. A second CNA, who also provided care to the resident that day, similarly stated that CNAs assist the resident with ROM exercises but confirmed they did not assist with ROM that day. The DON stated that staff are expected to follow residents’ care plans. These observations and interviews showed that the resident did not receive the ordered and care-planned daily active assisted ROM to the BLE, resulting in a failure to provide appropriate treatment and services to maintain or improve ROM/mobility or prevent further decline.
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