Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the services of a registered nurse (RN) for at least eight consecutive hours a day, seven days a week, as required. Review of facility documentation, including the facility assessment and RN punch detail records, revealed multiple dates where there was no evidence of RN coverage for the required period. The facility assessment indicated that staffing should include at least one RN per 24-hour period, with assignments based on patient care needs. However, on specific dates, there was no RN coverage documented, and the staffing coordinator confirmed that RN coverage was not consistently met. When an RN was unavailable, the Director of Nursing (DON) would occasionally cover the RN floor nurse role, and at other times, LPNs or the staffing coordinator would fill in, despite being aware that this did not meet the facility's expectations or regulatory requirements. Interviews with the staffing coordinator and DON confirmed awareness of the requirement for RN coverage and acknowledged that the facility did not always meet this standard. The clinical resource staff also noted that the facility had lower RN hours, particularly on weekends, compared to competitors, and that this issue would be addressed in future quality performance discussions. The census during the review period ranged from 38 to 67 residents, with a sample of 20 residents reviewed. The lack of consistent RN coverage could result in residents not receiving advanced care activities to meet their needs, as stated in the report.