A resident with mild cognitive impairment, hemiplegia, hemiparesis, and limited ROM had restorative orders for PROM, stretching, and hand splints, but staff did not consistently offer or complete the interventions. Documentation showed the splints were sometimes marked not applicable instead of refused, and leg stretches were completed only a few times with no explanation for missed care. Staff interviews confirmed the restorative tasks often were not done, and the DON stated the resident’s restorative program needed to be updated.
Failure to provide ordered restorative exercise programs for multiple residents. Residents with dementia, impaired mobility, paraplegia, fractures, and limited ROM had FMPs for ROM, strengthening, standing, and ambulation, but restorative logs showed few completed sessions, missed ambulation, and documented refusals. Staff said restorative aides were often pulled to the floor, nursing staff handled ambulation, and documentation did not always reflect whether residents were offered the exercises.
A resident with vascular dementia, aphasia, hemiplegia/hemiparesis, depression, anxiety, and a history of stroke and temporal lobectomy did not consistently receive ordered ROM/PROM. The care plan directed daily ROM with AM/PM cares, but the care assignment sheet and EMR task tabs lacked matching directions, and ROM was documented only a few times over the review period. Staff interviews showed the RNA provided PROM only several times per week, nursing staff were unaware of the twice-daily ROM direction, and the ADON acknowledged discrepancies between the care plan, care list, and EMR documentation.
Failure to perform a scheduled PROM program for a resident with MS and paraplegia. The resident was cognitively intact, had impairment to one upper extremity and both lower extremities, and the care plan required PROM/stretching once each shift. Documentation showed multiple shifts marked not performed, not applicable, or left blank, and the resident was observed with contractures of the right upper extremity and both lower extremities. The resident stated staff often forgot the PROM, and an NA and the DON confirmed the expected documentation was yes or refused when the program was completed or declined.
Failure to implement a ROM functional maintenance program for a resident with moderate cognitive impairment, cerebral palsy, hemiplegia, and bilateral lower-extremity contractures. Therapy had established an FMP with complete ROM to both lower extremities 3 times daily, but the EMR showed no evidence the program was started or routinely completed. CNA sheets referenced ROM, yet staff confirmed no ROM exercises were being performed and the RN case manager stated no ROM program was in place.
A resident with Alzheimer's disease and heart disease had a care plan directing staff to ambulate her with a walker and assist of one to meals and the bathroom, but ambulation was not assigned on aide task sheets and was not documented as attempted or completed. Staff observed the resident wheeling herself to breakfast without offering ambulation assistance, and interviews showed confusion about whether she was being walked. When later offered, she was able to ambulate with a walker, gait belt, and assistance, requiring frequent verbal prompts and moderate physical assistance.
Failure to provide planned restorative ROM services: A resident with cerebral palsy, dementia, and impaired lower-extremity mobility was care planned for daily restorative exercise with an arm bike to maintain upper body strength, but staff did not consistently provide the service. The resident said staff did not do ROM exercises, an NA could not recall the last time restorative care was completed, the DON acknowledged gaps in the program, and the assigned aide said the resident was not on her list and she had not done restorative exercises with him.
Failure to follow a therapy-recommended ambulation program for a resident with intact cognition who needed supervision/touch assist for ambulation. The resident’s care plan directed staff to assist him to walk to meals with a FWW and provide walking help with restroom use, but observations showed him propelling himself in a wheelchair to the dining room while staff made no attempt to encourage ambulation. The resident said he wanted to walk more and that staff did not offer as often as they used to; interviews with NA and RN leadership confirmed the ambulation assistance was expected and no refusal documentation was found.
Failure to consistently provide daily passive ROM for a resident with impaired ROM in both lower extremities. The resident’s MDS, therapy referral, care plan, and task list all directed daily passive ROM to the hips, knees, and ankles, but the task record showed refusals, incomplete documentation, and missed entries. The resident said staff were supposed to do ROM daily but never did it, and NAs said they often could not complete it because they did not have enough time. The DON acknowledged staff should be completing ROM daily.
Failure to provide ROM and proper hand splint application. A resident with left-sided hemiplegia after a stroke had orders for PT/OT and a resting hand splint, but EMR documentation showed ROM was completed only twice in 30 days and the splint task only 12 times. During observations, staff applied the splint incorrectly, with the palmar support not placed in the palm or placed under clenched fingers. The OT corrected the splint, and staff interviews showed confusion about who was responsible for ROM and splint care.
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