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F0940
E

Failure to Document and Complete Mandatory Staff In-Service Trainings

Windham, Connecticut Survey Completed on 04-22-2025

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 ensure that mandatory employee training and in-service requirements were completed and documented for four out of five reviewed staff members. Specifically, the employee files for an LPN and three nursing assistants did not contain evidence that required in-service trainings on Resident Rights, Communication, and Behavioral Health had been provided from 2023 to the present. Despite requests, the facility was unable to produce documentation confirming completion of these mandatory trainings for the identified staff members. Interviews with the Staff Development RN and the Director of Nursing revealed that it was the responsibility of the Staff Development RN to ensure completion, documentation, and filing of required in-service trainings. Both the Staff Development RN and the Director of Nursing were unable to locate the necessary documentation and acknowledged that the trainings should have been completed upon hire and annually, as per facility policy. The facility's policy on employee in-service trainings was also not provided when requested.

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