Failure to Maintain 24-Hour Licensed Nurse Coverage
Penalty
Summary
The facility failed to maintain sufficient nursing staff coverage at all times, as evidenced by gaps in nurse scheduling and documentation. Review of nursing schedules and time sheets over several days showed multiple periods where no licensed nurse was scheduled or documented as present, including overnight and evening hours. On several occasions, there was no nurse coverage for several hours, and in one instance, a nurse worked a 26-hour shift due to lack of available staff. The Director of Nursing (DON) and other salaried staff often worked extended hours to cover these gaps, but did not consistently document their additional hours. PRN staff hours were also not reliably recorded, as they were not included in the time clock system and handwritten records were incomplete or missing. Interviews with staff confirmed that nurses were working extended shifts, sometimes up to 24 hours, because there was no one to relieve them. The Business Office Manager acknowledged difficulties in tracking PRN staff hours and stated that some records could not be located. The Administrator expressed concern about the impact of long hours on staff performance but stated that the corporation would not provide agency staff. The facility census at the time was 39 residents, and the facility's own policy required 24-hour licensed nurse coverage, which was not consistently met according to the documentation reviewed.