DON Performed Charge Nurse and CNA Duties Despite High Census
Penalty
Summary
The facility failed to ensure that the Director of Nursing (DON) did not serve as a charge nurse or Certified Nursing Assistant (CNA) when the average daily occupancy was 60 or more residents, as required. Record reviews showed that the DON performed CNA duties on 15 separate days and served as a charge nurse on one day during the month of October, despite the census ranging from 66 to 72 residents. Documentation and interviews confirmed that the DON regularly provided direct care, including incontinent care, dressing residents, and rounding, often due to staff call-ins and shortages. The DON stated she was unaware of the regulation prohibiting her from working as a CNA or charge nurse when the census exceeded 60 and explained that she stepped in to ensure residents received care when staffing was insufficient. Interviews with other staff, including LVNs and the ADON, corroborated that the DON and ADON frequently worked on the floor to cover for absent staff. The Administrator and Regional Nurse Consultant (RNC) were also aware of the DON's actions but were not familiar with the regulatory requirement restricting the DON from performing these roles at higher census levels. The DON's job description included augmenting floor staffing if needed, but the facility did not ensure the DON was able to fulfill her designated administrative duties for 40 hours per week due to her involvement in direct care tasks.