Two residents did not receive restorative nursing services as ordered to maintain or improve ROM and functional abilities. One resident with chronic inflammatory demyelinating polyneuritis and bradycardia had active orders and an evaluation for passive bilateral ankle ROM and bed mobility to sitting at the edge of the bed, but task logs over a month showed the services were rarely provided, frequently marked as Not Applicable, and often recorded as refused despite the resident reporting only one refusal and stating staff said no one was available to run the program; the resident filed a grievance that the facility could not produce. Another resident with malignant neuroleptic syndrome and catatonic schizophrenia had an order for daily 15‑minute hand‑over‑hand grooming ADLs, yet documentation over a month showed multiple days with no entries, many days where the 15‑minute goal was not met, and numerous Not Applicable entries. The ADON, who oversaw the restorative program and assigned CNAs to complete and document it, confirmed that the documentation reflected that restorative nursing was not being provided as ordered and stated that refusals should be documented in progress notes and that Not Applicable was not an appropriate entry.
Failure to Apply Ordered Orthotic Devices: Four residents with ROM limitations and contractures had ordered orthotic devices documented on the MAR, but survey observations found the devices not in place at various times. Residents with diagnoses including muscle weakness, stiff-man syndrome, spinal stenosis, and stroke were seen without splints, knee braces, or PRAFO boots despite care plans and MAR directions for contracture prevention; one resident reported not wearing the boots in quite some time, and another said the splint was not applied regularly.
Failure to Allow A Resident to Use Own Power Wheelchair: A resident with MS and depression was not allowed to use her own PWC in the facility, despite OT documentation that she used it at home, was safe to operate it, and could transfer independently without a slide board. She reported she could only tolerate a couple of hours in the facility wheelchair, had not been up for days, and was not told at admission she could not keep her PWC. Staff interviews showed the BOM did not review the PWC policy during admission, and the NHA acknowledged the resident would benefit from using her custom PWC in her room.
A resident with incomplete paraplegia, chronic pain, and a stage 3 sacral pressure ulcer lost upper-extremity mobility while in the facility. Staff did not provide ROM as expected, repositioning was not done every 2 hours as care planned, and the resident reported that care often consisted only of brief changes. The resident also reported pain during wound care and repositioning, and the scheduled opioid dose was given after morning wound treatment.
Failure to provide ordered splinting and ROM services for two residents with contractures and severe cognitive impairment. One resident with CVA-related hemiplegia had a right resting hand splint order and restorative ROM/splint care planned, but the splint was observed off and the facility had no restorative documentation. Another resident with hand contractures had orders for bilateral palm guards and BUE/BLE ROM, but staff reported restorative care was not consistently provided, and logs showed missed splinting and ROM with no refusals documented.
Failure to implement a restorative ROM program for a resident with left lower extremity impairment and limited mobility. The resident was observed seated in a wheelchair with the legs extended and the left leg bent outward, while PT and OT discharge summaries recommended restorative services including lower extremity strengthening, passive ROM, AAROM, AROM, and restorative ROM. Staff reported a referral had been made, but the resident was not yet on the restorative program because the caseload was too large and the resident was on a waiting list.
A resident with dementia, rheumatoid arthritis, left-sided paralysis, and wheelchair dependence had a contracted left hand and limited left arm movement, and stated staff had not been performing ROM to the left hand or arm. The chart listed restorative nursing AAROM for bilateral upper extremities, but there was no documentation that the task had been completed for the prior 30 days. The ADON confirmed the missing documentation, and the RD stated the resident was not receiving restorative nursing and could not explain the unmet ROM task.
Failure to provide restorative nursing services for two residents. One resident with quadriplegia and anoxic brain damage reported staff were not working with her contracted hand and were not consistently applying her splint, while records showed very limited documentation of PROM and brace assistance and no current MD order for restorative or splint use. Another resident with paraplegia said he no longer received ROM exercises and was having increasing difficulty using his arms and hands to feed himself. Staff stated restorative care was handled by the restorative aide, that CNAs did not usually do it, and that no one covered the program when the aide was unavailable.
A resident with limited mobility and multiple chronic conditions did not consistently receive restorative therapy services as ordered, with only partial documentation of therapy sessions and missed opportunities for care. Staff interviews confirmed both missed treatments and incomplete documentation, contrary to facility policy.
A resident with hemiplegia and cognitive impairment did not receive prescribed splint therapy for the left upper extremity as ordered, with multiple missed applications and lack of follow-up documentation or re-approach by licensed staff. The splint was found unused in the resident's drawer, and staff interviews confirmed the care plan was not consistently followed.
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