F0688

D

Failure to Implement Restorative Nursing Program for ROM and Mobility

Tacoma, Washington Survey Completed on 03-19-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to initiate and provide a restorative nursing program for a resident with limited range of motion (ROM) and mobility needs after discharge from skilled therapy. The resident was admitted with diagnoses including stroke, aphasia, malnutrition, and depression, and the admission MDS documented that the resident did not walk, required partial to maximal assistance with ADLs, and was always incontinent of bowel and bladder. An observation showed the resident in bed with the right leg demonstrating full ROM while the left leg, hand, and arm appeared contracted. The PT discharge summary, dated mid-January, indicated that the resident was discharged from skilled PT services and had goals to improve active/passive ROM of the left hip and knee using splinting and ROM techniques, and to tolerate right knee splinting with functional ROM carryover. The PT discharge recommendations included continuing the resident’s splint and brace.

The care plan, dated late February, identified the resident as having limited physical mobility related to contractures and documented a referral to a Restorative Nurse Assistant. However, during interviews, the COTA stated that although a restorative nursing program had been written for the resident, it could not be located. The DNS reported that there was a restorative nursing program referral for right knee splinting three times per week, but the facility was unable to locate the referral or any documentation showing that a restorative nursing program was implemented for the resident between the PT discharge date in mid-January and the early March observation. This lack of implementation and documentation of the restorative nursing program led to the cited deficiency for failure to provide appropriate care to maintain or improve ROM and mobility.