Failure to Provide Mandatory QAPI Training to Staff
Penalty
No penalty information released
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 all staff, including both new hires and existing personnel, completed mandatory training on the Quality Assurance and Performance Improvement (QAPI) program. Personnel file reviews and the in-service attendance calendar revealed that six staff members, including LPNs and CNAs, did not have documentation of QAPI training upon hire or annually. The facility's training records did not list QAPI as a training topic, and an undated internal document indicated that training was required for all departments but lacked evidence of compliance. During staff interviews, the Director of Nursing confirmed the absence of additional QAPI education in staff files.