§483.25(c) Mobility.
§483.25(c)(1) The facility must ensure that a resident who enters the facility without limited range of motion does not experience reduction in range of motion unless the resident's clinical condition demonstrates that a reduction in range of motion is unavoidable; and
§483.25(c)(2) A resident with limited range of motion receives appropriate treatment and services to increase range of motion and/or to prevent further decrease in range of motion.
§483.25(c)(3) A resident with limited mobility receives appropriate services, equipment, and assistance to maintain or improve mobility with the maximum practicable independence unless a reduction in mobility is demonstrably unavoidable.
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Observations:
Based on clinical record review and resident and staff interview, it was determined that the facility failed to provide services to maintain a resident's mobility for one of seven residents reviewed (Resident 6).
Findings include:
Interview with Resident 6 on June 3, 2024, at 12:50 PM revealed that staff have not walked with her per her walking program. Resident 6 stated that she believed that there were not enough staff to walk with her, and the facility restructured their nurse aide staffing to no longer have dedicated restorative nursing aides.
Clinical record review for Resident 6 revealed a plan of care developed by the facility to address her deficit with self-care of activities of daily living (ADL) performance. Interventions for the plan of care included a nursing rehabilitation program to ambulate 200-250 feet twice with one staff assist, a roller walker, and a wheelchair following (as resident may get dizzy).
Review of Task documentation (electronic system of nurse aide documentation of activities of daily living care) dated May 2024, and June 2024, revealed that staff failed to assist Resident 6 with her restorative ambulation program on May 2, 3, 4, 5, 6, 7, 10, 11, 16, 18, 20, 25, 26, 29, 30, 31, 2024, and June 2, 2024.
The surveyor reviewed the above concerns regarding Resident 6's restorative nursing program during an interview with the Nursing Home Administrator and the Director of Nursing on June 3, 2024, at 2:45 PM.
483.25(c)(1)-(3) Increase/prevent Decrease In ROM/mobility
Previously cited deficiency 12/8/23
28 Pa. Code 211.12(d)(1)(5) Nursing services
| | Plan of Correction - To be completed: 06/27/2024
F0688
1. RNP was restructured that includes the nurse aides to complete the RNP for residents. PT will evaluate resident #6 for ambulation status. Ambulation status will be documented in residents care plan, task and physician orders.
2. DON or designee will complete house wide audit for residents that are on a program for ambulation to ensure the program is completed and documented in the EMR and program documented on care plan, task and physician orders.
3. Staff Development Coordinator or designee will educate facility nurse aides to ensure the program is being completed for residents on an ambulation program.
6. DON or designee will complete random audits weekly x 4 weeks and then monthly x 2 to ensure residents ambulation programs are completed and documented on care plan, task, physician orders. Findings of audits will be reported to QAPI x 3 months.
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