Failure to Provide Required RN Coverage and Oversight
Penalty
Summary
The facility failed to provide the services of a registered nurse (RN) for at least 8 consecutive hours a day, 7 days a week, as required. Review of RN coverage hours revealed that there was no RN coverage for 8 consecutive hours on the majority of days across four months, specifically 30 of 31 days in January, 19 of 28 days in February, 20 of 31 days in March, and 20 of 30 days in April. This lack of RN coverage was confirmed through interviews and record reviews, with no documentation available to show that an RN was present or overseeing care during these periods. Interviews with facility staff, including the Assistant Director of Nursing (ADON), Director of Nursing (DON), Corporate RN, and Administrator, revealed a lack of awareness and oversight regarding RN coverage. The ADON acknowledged the absence of an RN on many days and was unable to confirm if resident assessments had been completed or who had overseen the practice of Certified Nurse's Aides (CNAs) during this time. The DON stated that her hours were not recorded and could not confirm how staffing hours were reported for Payroll-Based Journal (PBJ) submissions. The Corporate RN was unaware of the lack of RN coverage and stated that no agency staff had been called to fill the gaps. The Administrator, new to her position, was also unaware of the RN coverage issue and could not provide documentation regarding oversight of CNAs or the use of agency RNs. Facility policy requires the use of a registered nurse for at least 8 consecutive hours per day, 7 days per week, and designates a registered nurse to serve as the DON on a full-time basis. The review of Texas Board of Nursing rules further clarifies the distinct roles and responsibilities of RNs and Licensed Vocational Nurses (LVNs), emphasizing that LVNs require appropriate supervision and cannot practice independently. The absence of RN coverage meant that resident assessments and oversight of care provided by LVNs and CNAs may not have occurred as required, and there was no documentation to support that these essential nursing functions were performed during the identified periods.