Failure to Ensure Nursing Assistant Competency and Orientation
Penalty
Summary
The facility failed to ensure that both employed and agency nursing assistants (NAs) received appropriate orientation, training, and supervision, as well as to verify and document their competency in providing resident care. Interviews with residents revealed concerns about agency staff lacking motivation, accountability, and knowledge of their job duties. Residents reported that agency NAs were unfamiliar with facility procedures, did not know how to use mechanical lifts, and sometimes asked residents for guidance on basic tasks and the location of supplies. Additionally, not all staff wore name tags, making it difficult for residents to distinguish between agency and employed staff. A review of the facility's orientation materials showed that the binder used for new employee and agency orientation was primarily focused on topics relevant to licensed nursing staff, with little job-specific information for NAs. There were no orientation checklists or documentation tools to ensure that NAs were trained in essential areas such as the use of mechanical lifts, location of supplies, resident preferences, transfer status, call light response times, or expectations regarding personal cell phone use. The assistant director of nursing (ADON) and director of nursing (DON) both confirmed that there was no documentation to verify that NAs had received or demonstrated required competencies, and that agency NAs did not have a specific orientation checklist. The only individualized resident care orientation provided to NAs was a single screenshot showing how to access the Kardex in the electronic medical record, and there was no follow-up to ensure agency NAs could access or use it. Employee files for two NAs showed missing or incomplete documentation of skill competencies and required in-service trainings. One NA had no skill competencies completed within the past year, while another had undated competency exams and incomplete Relias online training. The facility's own assessment and orientation policy described a comprehensive educational program and the use of checklists to ensure staff competency, but these practices were not reflected in the actual documentation or processes observed during the survey. The lack of proper orientation, training, and competency verification had the potential to affect all residents in the facility.