Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the required 8 hours per day, 7 days per week Registered Nurse (RN) coverage, as documented by the facility's nurse schedules and employee timecard reports. On multiple dates across June, July, and August 2025, there was either no RN scheduled or the scheduled RN, who was also the Director of Nursing (DON), worked less than the required 8 hours. Specific dates were identified where no RN was present, and on several occasions, the DON worked between 3 to 7.5 hours instead of the mandated 8 hours. Interviews with the DON and the Administrator confirmed awareness of the RN coverage shortfall. The DON acknowledged gaps in the schedule and noted that a PRN nurse had recently started to help cover shifts, while the facility continued to advertise for an RN position. At the time of the deficiency, 37 residents were residing in the facility, as documented in the Minimum Data Set (MDS) Resident Matrix.