Failure to Provide Full-Time Director of Nursing Coverage
Penalty
Summary
Facility staff failed to provide the services of a full-time Director of Nursing (DON) as required for facilities with an average daily occupancy of 60 or more residents. The facility census consistently exceeded 60, with an average daily census of 62. Review of facility records showed that the DON frequently worked as the charge nurse on multiple shifts, including both day and night shifts, instead of fulfilling the full-time administrative responsibilities of the DON role. The facility did not provide a policy for DON coverage, and the Facility Assessment documented the census but did not address the DON's administrative coverage. Interviews with staff and the administrator confirmed that the DON was responsible for scheduling and staffing of nurses, as well as hiring and terminating staff, but was also required to work as a charge nurse due to inadequate staffing levels. The administrator acknowledged ongoing staffing shortages and stated that the DON worked on the floor to ensure nurse coverage. The DON confirmed awareness of the requirement not to serve as a charge nurse when the census is over 60, but stated that staffing shortages necessitated this practice despite ongoing recruitment efforts.