DON Worked as Charge Nurse Despite High Census
Penalty
Summary
Facility staff failed to ensure that the Director of Nursing (DON) did not work as a charge nurse when the facility's average daily occupancy was 60 or more residents, as required by regulation. The facility assessment indicated an average daily census of 77 residents and identified the DON as necessary for resident care, but did not specify if the DON was a full-time staff member or how many hours were dedicated to the DON role. Additionally, the assessment did not clarify whether the DON was allocated to direct care duties. Review of the nursing schedules for September and October showed that the DON worked multiple night shifts as a charge nurse while the census ranged from 76 to 81 residents. During interviews, the DON confirmed working the floor to provide resident care due to a nurse being out with a medical issue and the recent resignation of the Assistant Director of Nursing (ADON). The DON stated that regional support was assisting with DON tasks during these periods. The Administrator also acknowledged awareness that the DON was working the floor.