Failure to Provide Required RN Coverage and Designate Full-Time DON
Penalty
Summary
Facility staff failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours per day, seven days a week, and did not designate a Director of Nursing (DON) on a full-time basis, as required by facility policy and federal regulations. Review of facility records, including the Facility Assessment Tool and daily punch records, showed that the facility had been without RN coverage for approximately three weeks prior to the new DON starting. Multiple staff interviews confirmed the absence of RN coverage during this period, with both LPN and CNA staff stating they had not observed an RN in the building. The Administrator was unable to provide proof of RN coverage and acknowledged that the previous DON had left some time ago, with the new DON only starting recently. Payroll and time records further substantiated the lack of RN presence, with no RN clock-ins documented on multiple days and shifts over several weeks. The facility's own policy required RN coverage for at least eight consecutive hours daily and a full-time DON, but these requirements were not met. The Administrator also failed to provide the requested Payroll Based Journal (PBJ) documentation to verify RN staffing. The deficiency was identified during a complaint investigation with a facility census of 56 residents.