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F0730
D

Failure to Conduct Timely and Documented CNA Performance Evaluations

Pomona, California Survey Completed on 07-25-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that performance evaluations (PEs) were conducted every 12 months for one out of four certified nursing assistants (CNAs) reviewed. Specifically, a review of personnel files revealed that one CNA was overdue for a PE, with no evaluation documented for the required period. The most recent PE for this CNA was signed only by the evaluator and not by the CNA, and the CNA confirmed during an interview that he had not seen or signed the evaluation. Additionally, the CNA stated he did not receive a PE in the previous year, and the last PE he recalled receiving and signing was from over a year prior. During interviews, the Director of Staff Development (DSD) and the Administrator acknowledged the lack of a formal policy for staff performance evaluation review, although a staff competency validation policy was provided. The policy outlined the purpose of competency validation but did not specifically address the requirement for annual performance evaluations. The absence of timely and properly documented PEs for the CNA had the potential to compromise resident safety and well-being, as regular evaluations are necessary to ensure staff competency.

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