Failure to Accurately Report Nursing Coverage in PBJ Data
Penalty
No penalty information released
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 submit complete and accurate direct care staffing information to CMS through Payroll-Based Journaling (PBJ) as required. Although the PBJ Staffing Data Report indicated that there was not 24-hour licensed nursing coverage on several dates across two fiscal quarters, a review of the facility's nursing schedule and payroll data confirmed that 24-hour nursing coverage was actually provided on those dates. The discrepancy was due to the facility's time-keeping system, which automatically deducted a 30-minute lunch period from the nurses' recorded hours, even though the nurses remained in the building during that time. The facility did not provide a policy related to PBJ reporting.