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F0728
E

Lack of Documentation for Nurse Aide Skill Competency

Austin, Texas Survey Completed on 11-24-2025

Penalty

No penalty information released
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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 nurse aides who had completed more than four months of employment were properly trained and deemed competent, and that those with less than four months of employment were enrolled in appropriate training. Record reviews for 13 nurse aides revealed that, although their training programs were reportedly completed, there was no documented proof of completion of the Nurse Aide Curriculum skill performance checklists in their employee records. This lack of documentation was consistent across all 13 nurse aides reviewed. Interviews with the Director of Nursing (DON), Administrator (ADM), and Staffing Coordinator confirmed that the skill performance checklists, which were supposed to be maintained in a binder, could not be located anywhere in the facility. All three staff members acknowledged that the binder was expected to be up to date and available for review, and that the absence of this documentation would appear as if the required skill checks had not been completed. The DON and Staffing Coordinator both stated that the skills had been checked off, but without the binder, there was no way to validate this claim. The facility's own Nurse Aide Qualification and training requirements specify that nurse aides must undergo a state-approved training program and complete a minimum of 16 hours of training in specific areas before having direct contact with residents. Despite these requirements, the facility was unable to provide evidence that the nurse aides had completed the necessary skill performance checklists, as required by both facility policy and state regulations.

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