Failure to Ensure Staff Competency in Specialized Resident Care
Penalty
Summary
Nursing staff at the facility failed to demonstrate competency in caring for residents with specialized needs, specifically those using a Posey Net Restraint Bed and those requiring medication administration via gastrostomy tube. Review of personnel files and staff interviews revealed that there was no documentation of training or competency assessments for staff responsible for residents with a Posey Net Bed, despite manufacturer recommendations requiring proper training. The Director of Nursing confirmed that no records existed to show that the relevant staff had received appropriate education or demonstrated competency in the use of the Posey Net Restraint Bed. Additionally, during a medication administration observation, a nurse administered medication through a gastrostomy tube without verifying tube placement or using a stethoscope, as required by facility protocol. The nurse admitted to not having a stethoscope available and could not provide evidence of competency in this procedure. The facility administrator also confirmed the absence of competency records for medication administration via gastrostomy tube, and noted that the staff educator had left the facility several months prior, leaving a gap in staff development and competency verification.