|§483.24(a) Based on the comprehensive assessment of a resident and consistent with the resident's needs and choices, the facility must provide the necessary care and services to ensure that a resident's abilities in activities of daily living do not diminish unless circumstances of the individual's clinical condition demonstrate that such diminution was unavoidable. This includes the facility ensuring that:|
§483.24(a)(1) A resident is given the appropriate treatment and services to maintain or improve his or her ability to carry out the activities of daily living, including those specified in paragraph (b) of this section ...
§483.24(b) Activities of daily living.
The facility must provide care and services in accordance with paragraph (a) for the following activities of daily living:
§483.24(b)(1) Hygiene -bathing, dressing, grooming, and oral care,
§483.24(b)(2) Mobility-transfer and ambulation, including walking,
§483.24(b)(4) Dining-eating, including meals and snacks,
§483.24(b)(5) Communication, including
(iii) Other functional communication systems.
Based on review of policies and clinical records, as well as staff interviews, it was determined that the facility failed to ensure that residents received restorative ambulation programs to maintain or improve their abilities to walk in accordance with their physician's orders for three of nine residents reviewed (Residents 3, 5, 6).
The facility's policy regarding restorative nursing programs, dated February 20, 2019, indicated that a resident would receive restorative nursing care as needed to help promote optimal safety and independence.
A diagnosis record for Resident 3, dated December 1, 2018, revealed that the resident had diagnoses that included syncope (dizziness), seizures and a history of falls. Physician's orders, dated February 21, 2019, revealed that the resident's physical therapy was discontinued, that she was to be provided with restorative ambulation (walking), and was to ambulate up to 25 feet with a regular walker with the moderate assistance of two staff, with a wheelchair to follow.
As of February 28, 2019, there was no documented evidence that Resident 3 received restorative ambulation as ordered by the physician.
A diagnosis record for Resident 5, dated December 30, 2018, revealed that the resident had diagnoses that included dementia (brain disease that causes declines in the abilities to think and remember), stroke, muscle weakness and a history of falls. Physician's orders, dated February 8, 2019, revealed that the resident's physical therapy was discontinued, that he was to be provided with restorative ambulation, and was to ambulate 150 feet with a wheeled walker and minimal assistance.
As of February 28, 2019, there was no documented evidence that Resident 5 received restorative ambulation as ordered by the physician.
A diagnosis record for Resident 6, dated September 26, 2017, revealed that the resident had diagnoses that included a history of falls, joint disorder and dementia. Physician's orders, dated February 20, 2019, revealed that the resident's physical therapy was discontinued, that she was to be started on a restorative ambulation program, and was to ambulate 150 feet with stand-by assistance with a regular walker.
As of February 28, 2019, there was no documented evidence that Resident 6 received restorative ambulation as ordered by the physician.
Interview with the Director of Nursing on February 28, 2019, at 4:20 p.m. confirmed that there was no documented evidence that Residents 3, 5 and 6's restorative ambulation programs were provided as ordered by the physician.
28 Pa. Code 211.12(d)(3) Nursing services.
Previously cited 11/27/18, 11/7/18.
28 Pa. Code 211.12(d)(5) Nursing services.
Previously cited 11/27/18, 11/7/18.
| ||Plan of Correction - To be completed: 03/29/2019|
The filing of this plan of correction does not constitute an admission that the alleged deficiencies did, in fact, exist. This plan of corrections is filed as evidence to comply with requirements of participation and continue to provide high quality resident centered care.
1) Corrective Action for those residents found to be affected by the alleged deficient practice.
Resident #3, #5, #6 are currently receiving restorative services. Immediate education with nursing, nursing leadership, and the restorative nursing assistants regarding ensuring that the residents with restorative orders are receiving restorative services.
2) Corrective Actions taken for residents with potential to be affected by alleged deficient practice.
Residents admitted into the facility have the potential to be affected. Audit completed on residents with restorative orders to ensure resident is participating in restorative therapy and the documentation reflects the physician order or selected therapies.
3) Systemic Changes put into place to ensure the alleged deficient practice does not recur.
Restorative nursing modalities are being moved to the Point of Care nursing assistant charting system under the resident task list/Kardex for ease of charting, this will prevent residents from not receiving restorative services should the primary restorative assistant be pulled to the floor for call outs. The Director of Nursing has weekly meetings with the restorative nursing team and the rehabilitation team to address and evaluate current residents receiving restorative services as well as any potential restorative candidates and to check documentation.
4) Monitoring of corrective action to ensure the alleged deficient practice does not recur.
Director of nursing will audit the restorative nursing program weekly x 4 weeks and monthly x 2 months to ensure proper charting and documentation.
Plan of correction information and audits will be reviewed in the quality assurance and performance improvement process for tracking/trending and any necessary additional interventions.
Date of compliance-3/29/19