Failure to Ensure Nursing Staff Competency for Specialized and General Care
Penalty
Summary
The facility failed to ensure that nurses and nurse aides possessed the necessary competencies and skill sets to care for residents with specialized needs, including those with chest tubes, PICC lines, ventilators, and tracheostomies, as well as for general nursing competencies. Surveyors found that 16 staff members lacked documented competencies for chest tube and PICC line care, and 12 out of 47 staff reviewed had incomplete competencies for ventilator and tracheostomy care. Additionally, there were shifts where no competent RN was available to oversee the ventilator unit, and the facility did not have an effective process to ensure all new and agency staff had the required competencies. Interviews with staff revealed significant gaps in orientation and competency verification. Agency nurses reported receiving minimal orientation, often limited to a tour and basic computer access, with an 'ask and learn as you go' approach. New LPNs described inadequate orientation, lacking checklists and specific training for ventilator care. The staff development process was in transition, with the new Staff Development Specialist still developing a more robust system. There were also issues with the orientation checklist process, as checklists were often lost or not completed, and agency staff did not receive competency checklists at all. The facility relied on agencies to confirm competencies, but agencies reported not providing training on chest tubes or PICC lines. Documentation provided to surveyors regarding staff competencies was incomplete and disorganized. For ventilator and tracheostomy care, training packets were missing key components such as skills checklists, and some test documents were photocopied and placed in multiple staff files without individual identification. There was no master list to cross-reference which staff had completed required training, and the documentation did not consistently include names or dates. For the resident with a chest tube and PICC line, no staff or agency competencies were provided for the period the resident was in the facility, and education on these topics was only provided after the resident had left. These deficiencies were confirmed through interviews, record reviews, and direct observation by surveyors.