Failure to Provide Required RN Coverage When Census Exceeds 60 Residents
Penalty
Summary
Facility staff failed to ensure that a Registered Nurse (RN) was on duty for eight consecutive hours each day, separate from the Director of Nursing (DON), when the facility census exceeded 60 residents. Review of staffing sheets and census records over multiple dates showed that the DON regularly worked as the charge nurse during times when the census was above 60, contrary to the facility's own policy and regulatory requirements. The policy specifies that the DON may only serve as a charge nurse when the average daily occupancy is 60 or fewer residents. Interviews with the Administrator, staffing coordinator, and DON confirmed that the DON had been working as the RN charge nurse for several weeks due to a shortage of available RNs. The facility had only one other RN on staff, and both the DON and this RN alternated to cover required RN hours. The Administrator and DON acknowledged awareness of the requirement that the DON should not be counted as the floor RN when the census is above 60, but cited ongoing staffing challenges as the reason for noncompliance.