Missing Documentation of Nurse Training and Competency Assessments
Penalty
Summary
The facility failed to maintain records of annual training and competency assessments for two registered nurses in key areas of resident care, including medication administration, tube feeding administration and care, wound care assessment, monitoring and treatment, and safe transfers during care. The facility assessment indicated that residents were at risk for falls, required increased assistance with activities of daily living, had behavioral health and dementia needs, were prescribed psychoactive medications, had skin integrity issues, and required tube feedings and pressure ulcer care. During the review, it was found that there was no documentation available to confirm that the nursing staff had completed the necessary training and competency evaluations for these critical care areas. This was confirmed by the designated nurse trainer, who acknowledged the absence of the required records for the staff members reviewed.