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F0730
F

Failure to Complete Annual CNA Performance Reviews and In-Service Education

Colorado Springs, Colorado Survey Completed on 04-17-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to complete annual performance reviews for two certified nurse aides (CNAs) and did not provide regular in-service education based on the outcomes of these reviews. Record review showed that both CNAs, one hired in 2020 and the other in 2008, did not have documented annual performance evaluations. The facility was unable to provide these records when requested, indicating that the required reviews had not been conducted. Interviews with the director of nursing (DON) confirmed that the facility's policy requires annual performance reviews and regular in-service education for CNAs, but these had not been completed for the two CNAs in question. The DON acknowledged the absence of the reviews and stated that the purpose of the evaluations is to assess job performance, identify areas needing improvement, and provide feedback. The lack of completed reviews and corresponding in-service education constituted the deficiency identified during the survey.

See complete original report
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