A resident with intact cognition, ADL self-care deficits, and dependence on staff for ambulation and transfers did not receive the ordered restorative ROM program recommended by therapy. Although therapy issued recommendations for active ROM exercises to the lower extremities and nursing notes indicated that restorative referrals were received and that the resident was "continuing" a restorative program, there was no documentation that the specific exercises were carried out. Staff interviews revealed that therapy referrals to restorative were not effectively communicated, the restorative aide reported never receiving a PT referral and confirmed the resident did not receive restorative services, and nursing leadership acknowledged a lapse in administering the restorative program over an extended period, contrary to the facility’s restorative nursing policy.
Failure to Provide Scheduled Restorative ROM Program: A resident with quadriplegia, depression, bipolar disorder, and CVA had a care plan for restorative ROM and stretching 5-7 times per week, but restorative therapy was missed on multiple occasions. The resident stated therapy was not provided when the restorative aide was off duty, while the restorative aide said floor staff were supposed to complete it. CNAs said they were not aware they were expected to provide the restorative program, and the DON stated staff should complete the same routine when the restorative aide was absent. The facility had no policy for restorative therapy.
A facility failed to consistently provide restorative ROM services for two residents with limited mobility and dependence in ADLs. One resident reported therapy had stopped after admission and wanted therapy again, while the other said staff were frequently pulled to the floor. EHR review showed restorative tasks were scheduled, but documentation reflected missed or incomplete sessions, and staff said restorative aides were often reassigned to CNA duties, preventing the tasks from being completed as written.
The facility failed to ensure restorative nursing programs to maintain or improve ROM, strength, and mobility were developed and implemented under RN guidance for two residents. One resident with stroke-related ROM limitations had a care plan listing PROM, AROM, splint/brace use, and transfers, but the RNA reported independently creating the program at readmission, defaulting to PROM based on her own judgment, and was unaware of the resident’s expectation for a new leg brace and additional gait work. Another resident with normal cognition and no ROM limitations had a restorative care plan for ambulation, AROM, and ADLs but reported attending restorative nursing only once, despite staff describing multiple prescribed exercises. Interviews showed restorative programs were primarily written and adjusted by RNAs and an LPN MDS coordinator, with informal, non-RN training and no documented active RN oversight, contrary to facility policy requiring restorative programs to be set up based on comprehensive assessment and under appropriate supervision.
Surveyors found that the facility failed to provide appropriate ROM services and implement ordered interventions for two residents with post-stroke hemiplegia and hand contractures. One resident had a tightly contracted hand with fingernails pressing into the palm, no splint or padding in place, no therapy for the contracture, and no specific orders or care plan interventions addressing the hand, leading the resident to place tissues in the palm independently. Another resident had contracted fingers with no padding, reported no restorative exercises and no splint, despite a physician’s order for a left hand splint. The ARNP and OT cited insurance coverage issues and had not completed evaluations or treatments, and the DON was unable to identify what actions had been taken to follow the splint order, contrary to facility policy requiring therapy referral and provision of appropriate ROM interventions and equipment.
Three residents with conditions such as COPD, cerebral palsy, and morbid obesity were not provided with restorative nursing programs despite care plans indicating the need for exercise and therapy interventions. Residents expressed a desire to use exercise equipment to maintain or improve mobility, but were denied due to lack of staff and absence of a restorative program, as confirmed by staff and administration.
A resident with lower extremity impairment and intact cognition did not consistently receive restorative nursing interventions as recommended by therapy, due to inconsistent staff assignment and lack of dedicated restorative personnel. The care plan outlined specific exercises and activities, but staff interviews revealed that restorative programming was often missed or inadequately implemented when the responsible staff member was reassigned to other duties.
A resident did not receive the necessary care and services to maintain or improve ROM, limited ROM, or mobility, and there was no documented medical reason for the decline.
A resident with a history of arthritis, muscle weakness, and a right above-the-knee amputation did not receive restorative exercises or ambulation assistance as recommended by therapy and outlined in the care plan. Despite multiple therapy evaluations and clear directives, staff did not consistently implement or document restorative programs, and interviews revealed confusion about responsibility and documentation. The facility's policy required individualized restorative care, but this was not provided, resulting in a deficiency.
Several residents with limited ROM and mobility impairments did not consistently receive restorative care or therapy-recommended interventions as directed in their care plans. Documentation was often incomplete or missing, and residents reported being unable to participate in exercises or use equipment due to staff unavailability. Staff interviews confirmed the lack of a designated restorative aide, with CNAs expected to perform restorative activities but unable to do so regularly because of staffing shortages and other duties.
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