CNAs Assigned to Subacute Unit Without Required Training or Orientation
Penalty
Summary
Two Certified Nursing Assistants (CNAs) were assigned to work in the Subacute Unit without receiving the necessary training or orientation specific to that unit. Both CNAs reported in interviews that they had not been trained prior to floating to the Subacute Unit and expressed feeling unsafe and unprepared to care for residents requiring more intensive care, including those with ventilators. Review of staffing records confirmed that at least one CNA was assigned to the Subacute Unit on a specific date without prior training. Interviews with facility leadership, including the Registered Nurse Supervisor, Director of Staff Development (DSD), and Director of Nursing (DON), confirmed that CNAs should receive additional training and orientation before working in the Subacute Unit due to the specialized needs of the residents. The DSD and DON acknowledged there was no documentation of training or orientation for the CNAs in question, and the DSD's job description indicated responsibility for coordinating ongoing in-service training for all employees. The lack of training and documentation had the potential to result in inadequate care for residents in the Subacute Unit.
Plan Of Correction
Competent Nursing Staff How corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: On 05/22/2025, CNA 1 was provided training and orientation to work in the Subacute Unit. Competencies were completed and filed on the employee's file. On 05/22/2025, CNA 2 was provided training and orientation to work in the Subacute Unit. Competencies were completed and filed on the employee's file. On 05/22/2025, The Administrator/ DON provided a 1 on 1 education to the new DSD and DSD Assistant on ensuring that all licensed and certified staff assigned to the Subacute Unit shall receive orientation, training and competencies prior to any assignment on the floor and a retraining shall be provided as needed. On 05/22/2025, residents identified to be under the care of CNA 1 in the Subacute Unit on 05/09/2025 were assessed and no negative findings were noted. On 05/22/2025, residents identified to be under the care of CNA 2 in the Subacute Unit on 05/09/2025 were assessed and no negative findings were noted. How the facility will identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken: On 05/22/2025 and 05/23/2025, DON/DSD/Designee reviewed the employee files of licensed and certified staff assigned to work for the Subacute Unit in the past 30 days and found no other licensed or certified staff were scheduled without orientation, training and competencies for the unit; hence, no other residents were affected by the deficient practice. What measures will be put into place or what systemic changes the facility will make to ensure that the deficient practice does not recur: On 05/22/2025, The Administrator/ DON provided a 1 on 1 education to the new DSD and DSD Assistant on ensuring that all licensed and certified staff assigned to the Subacute Unit shall receive orientation, training and competencies prior to any assignment on the floor and retraining shall be provided as needed. On 05/22/2025 and 05/23/2025, Administrator, DON/Designee initiated an in-service education to Licensed Nurses, Certified Nursing Assistants, and Restorative Nursing Assistants on assuring that they receive the necessary orientation, training and competency to ensure that residents under their care will receive the appropriate care. A tracking log was created to ensure that all staff orientation, training, re- training and competencies are documented and filed in each respective employee file. This file will be kept by the DSD and will be updated accordingly. All licensed and certified staff members who do not have any documented Subacute orientation, training, retraining or competencies will not be scheduled in the Subacute Unit. How the facility plans to monitor its performance to make sure that solutions are sustained: The Administrator/Designee will conduct an audit of the DSD's tracking log for 4 weeks then bi- weekly for 3 months, to ensure that staff assigned to the Subacute Unit have the proper orientation, training, retraining and competencies needed prior to being assigned in the unit. Any issues identified will be addressed immediately. The Administrator will present the results of the above reviews to the Quality Assurance and Performance Improvement Committee for review and recommendations monthly for 3 months then quarterly thereafter. The plan will be reevaluated monthly by the QA Committee and make necessary changes as warranted to ensure that safety of the residents. Completion Date: 05/30/2025 F 726