DON Inappropriately Assigned as Charge Nurse Despite Occupancy Above Regulatory Threshold
Penalty
Summary
The facility failed to ensure that the Director of Nursing (DON) did not serve as the charge nurse except when the average daily occupancy was 60 or fewer residents. Review of the DON's position description confirmed that the role is intended to oversee the Nursing Services Department in accordance with regulations. However, multiple daily nursing assignment records showed that the DON was scheduled to work as a nurse or charge nurse on several occasions, including both day and night shifts, to cover for staff shortages. These assignments occurred despite the facility's occupancy consistently ranging from 72 to 91 residents over the past two years, exceeding the regulatory threshold. Interviews with the DON and the Administrator confirmed that the DON regularly served as the charge nurse, sometimes twice a week, due to ongoing staffing shortages. The DON reported actively working on the medication cart during these shifts. The Administrator acknowledged awareness of staffing shortages but was not aware of the regulatory requirement restricting the DON from serving as charge nurse under these circumstances and stated there was no policy addressing this issue.