|§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.
Based on review of clinical records, review of facility documentation, and review of facility policy and resident and staff interviews, it was determined that the facility failed to provide restorative nursing services for ambulation and range of motion for one of 20 residents reviewed (Resident R17).
Review of facility policy, "Restorative Nursing", dated, April 2014, indicated, "The restorative process is based on the premise that basic human needs are universal and fulfillment of those needs is imperative to the resident's well-being."
During an interview with Resident R17 on September 17, 2019, at 10:30 a.m. it was stated by the resident the desire to walk more often. The resident additionally indicated that "staff are so busy or not enough staff to help me walk."
Clinical record review revealed a quarterly MDS, (Minimum Data Set -periodic assessment of needs), dated June 21, 2019, which indicated Resident R21 required extensive assistance, (resident involved in activity, staff provide weight bearing support) with one person physical assist.
Review of therapy progress notes revealed Resident R17, was discharged from therapy services on March 4, 2019. Interview with Physical/Occupational Therapy (PT/OT) Director, Employee E11 on September 20, 2019, at 1:00 p.m. indicated that Resident R17 was to receive a Restorative Nursing Program (RNP- a daily program, with oversite by a staff person to assist a resident in maintaining functional status that improved, as a result of receiving therapy services, such as daily walking) on an ongoing basis after discharge from therapy services.
Further review of therapy progress notes revealed a RNP - Recommendations, dated, March 25, 2019, which indicated, Resident R17 would facilitate daily functional ambulation on the unit hallway, (10-20 feet), using a rolling waker and facilitate daily active range of motion of lower extremities, by all major planes of motion in seated position.
A follow up interview with Employee E11, PT/OT Director, on September 20, 2019, 9:15 a.m. indicated that RNP for Resident R17, would have maintained daily living skills such as walking and range of motion.
An interview with the Director of Nursing on September 20, 2019, at 11:15 a.m. revealed that the facility had not had a designated staff person to fulfill Restorative Nursing Program duties for residents including, Resident R17, during the time period of November 17, 2018 to May 12, 2019 and May 30, 2019 to the time of the interview with the Director of Nursing, (September 20, 2019, at 11:15 a.m.).
The facility failed to provide restorative nursing services for ambulation and range of motion to Resident R17.
28 Pa. Code 201.18(b)(2) Management
28 Pa. Code 211.10(d) Resident care policies
28 Pa. Code 211.12(d)(3)(5) Nursing services
| ||Plan of Correction - To be completed: 10/18/2019|
Preparation and/or execution of this plan of correction does not constitute admission or agreement by the providers of the truth of the facts alleged or conclusions set forth in the statement of deficiencies. This plan of correction is prepared solely as a matter of compliance with federal and state law.
The resident (R17) was screened on 10/4/19. Resident agreeable to work with physical therapy with goal to develop an RNP for ambulation.
Residents are screened by the care team on a quarterly basis to monitor for changes in functional performance and are referred for therapy when appropriate. When a resident is discharged from rehabilitation therapy services and requires restorative services, the rehabilitation department will communicate the specific needs/plan of the resident to the restorative nurse and aides via the restorative nursing program recommendations form. This plan will then be implemented per therapy communicated instructions. The resident's plan of care will be updated to reflect all new approaches/interventions.
Residents who are being discharged from therapy services will be discussed in the daily morning meeting. Those residents who have been discharged with a recommendation for an RNP will be reviewed by the care team and will have a plan of care developed.
The RNACs will monitor the program on a monthly basis thereafter and will report to QAPI for 6 months. Director of Nursing or designee will conduct weekly audits for 4 weeks, then monthly for six months to check that proper documentation regarding a resident's participation and progress in a restorative nursing program is maintained. The results of the audits will be reported to QAPI for six months.