F0688

D

Failure to Apply Ordered Palm Guards for Resident With Hand Contractures

Kernersville, North Carolina Survey Completed on 03-19-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide ordered care to maintain range of motion for a dependent resident with bilateral hand contractures. The resident had been evaluated by therapy, which determined he had reached maximum potential and required daily use of bilateral palm guards to maintain mobility and prevent skin irritation. Physician orders and the care plan directed that palm guards be worn on both hands for 6 hours daily or as tolerated, with removal only for ROM exercises, eating, hygiene, and ADL care, and with daily skin checks. The MAR for March documented that palm guards were to be applied up to 6 hours daily and showed they were signed as applied at 9:00 AM from the 1st through the 18th.

During multiple observations over several days, surveyors noted the resident’s hands were in loose-fisted contracted positions and that the ordered palm guards were not on his hands and were not present in his room. The resident reported he had palm guards but had not worn them in a long time, stated he had not refused them, and said he would wear them as ordered. Staff interviews revealed that nurse aides were expected to apply the palm guards after care and nurses were to ensure they were in place, but the assigned nurse could not recall when she last saw the resident wearing them and had not yet completed the treatment on the day of review. A nurse aide stated she had not seen the palm guards in a long time and believed they had been lost, and attempts to locate them were unsuccessful. Therapy confirmed that palm guards had been issued and that nursing was responsible for their ongoing application under a functional maintenance program, but the DON reported she had not been informed that the palm guards were missing.