Failure to Maintain Full-Time DON and Required RN Coverage
Penalty
Summary
The facility failed to ensure the presence of a full-time Director of Nursing (DON) and did not provide Registered Nurse (RN) coverage for at least 8 consecutive hours per day, 7 days a week, as required. Review of facility records, including census data, staffing schedules, daily assignment sheets, and timecards, revealed that for multiple audited dates, there was no RN coverage for periods of 24 hours or more. The facility's own assessment documented a high level of resident care needs, including oxygen therapy, CPAP/BIPAP management, and significant assistance with activities of daily living, yet staffing levels did not meet the documented requirements. Interviews with staff confirmed that agency nurses used to supplement staffing were LPNs, not RNs, and that the only full-time RN worked night shifts, leaving day and evening shifts without required RN coverage. Further, the facility had no in-house DON for several months prior to the survey, as confirmed by both the administrator and the human resources director. The DON position was vacant until a new hire started, and during the vacancy, a regional consulting nurse was present only intermittently. Staff reported being short-staffed, with LPNs covering multiple halls and having to assist with resident care beyond their usual duties. The lack of RN coverage and absence of a full-time DON had the potential to affect all 82 residents, many of whom required complex care and behavioral health management.