Failure to Provide Sufficient RN Staffing for Medication Administration and Resident Assessments
Penalty
Summary
The facility failed to provide sufficient nursing staff with the appropriate skill sets to meet the needs of residents, specifically by not having a Registered Nurse (RN) available during an overnight shift. This resulted in missed administration of prescribed intravenous antibiotics through a PICC line for a resident with complex medical needs, including a partial foot amputation, wound dehiscence, bloodstream infection, and gangrene. The resident's medication administration record showed that two doses of antibiotics were not given as ordered because there was no RN present to administer medications via the PICC line, as required by state regulations. Additionally, two residents who experienced unwitnessed falls during the same overnight shift did not receive post-fall written assessments by an RN, but rather by an LPN, contrary to state requirements. Staffing records confirmed that no RN was scheduled for the shift in question, and interviews with staff and administration corroborated that the RN who had been working was sent home after a 16-hour shift, and the DON was unable to stay to provide coverage. These actions led to the facility's failure to comply with regulations regarding nursing services and resident assessments.