Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the required registered nurse (RN) coverage for at least 8 consecutive hours a day, 7 days a week, as evidenced by a review of daily sign-in schedules showing no RN charge nurse present on eight specific days within the review period. Interviews with facility staff, including the Assistant Director of Nursing (ADON), Director of Nursing (DON), and Administrator (ADM), confirmed that there was no RN coverage on weekends during this time frame. The ADON and DON both stated that if RN services were needed, they would reach out to the regional nurse or DON, but there was no established protocol for when an RN was unavailable. The facility had ongoing difficulties hiring an RN, particularly for weekend shifts, and had an open job posting for this position. The absence of an RN on duty was not due to a lack of need for RN-level care, but rather due to staffing challenges and the facility's belief that their resident population did not require high-acuity nursing services. The DON reported being present during weekdays, and the facility occasionally used agency RNs, but consistent weekend coverage was not maintained. There was no specific policy in place regarding RN coverage, and the facility relied on state guidelines and ad hoc arrangements when RN-level care was required.