Failure to Ensure Daily RN Coverage
Penalty
Summary
The facility failed to ensure that a Registered Nurse (RN) was on-site for at least 8 consecutive hours on a daily basis, as required. Payroll Based Journal (PBJ) staffing data for a specific quarter revealed that there was no RN coverage on at least one weekend day. Specifically, on one Sunday, an open RN shift was posted but was ultimately filled by an LPN instead of an RN, resulting in a lack of required RN presence. The facility's assessment indicated the need for one RN for 40 residents, and staffing schedules showed RNs were typically scheduled for 12-hour shifts. However, the absence of an RN on the identified day was not recognized as an error at the time. Interviews with facility staff, including the Director of Operations (DOO), Staffing Coordinator (SC), and Human Resources (HR), confirmed the processes in place for managing RN coverage, such as using the OnShift app to post open shifts, maintaining an on-call rotation, and having contingency plans for emergency staffing. Despite these measures, the facility's scheduling and oversight failed to prevent a lapse in RN coverage, as the open shift was inadvertently assigned to an LPN. Staff interviews also revealed a misunderstanding regarding the allowable number of days without RN coverage per quarter, with the SC believing a maximum of three days was permitted, though the goal was zero.