Failure to Post Daily Direct Care Staffing Numbers
Penalty
Summary
The facility failed to ensure that the daily Direct Care Staffing Numbers were posted and readily accessible for review, as required. On the day of surveyor observation, the placard at the front entrance, which is designated for staffing postings, was found empty during two separate checks in the morning. Interviews with facility staff revealed confusion regarding responsibility for the posting. The Staffing Coordinator, who was new and still in training, stated he was not responsible for the posting and had not been trained to complete it. The DON, who typically handled the posting, was on leave, and there was no clear delegation of the task in her absence. The Administrator was unaware of the specific regulations and did not know why the posting was not completed that day. The ADON believed the Staffing Coordinator was responsible but was unaware he had not been trained, resulting in the posting not being completed. Record review indicated that facility policy requires direct care daily staffing numbers to be posted for every shift by 10 am daily. However, the Administrator confirmed there was no specific policy on posting the Direct Care Daily Staffing Numbers, and the ADON stated she had been updating the posting daily since the DON went on leave, typically arriving between 7:45 and 8:00 am. On the day in question, the posting was not completed due to a lack of training and clear assignment of responsibility, leading to the deficiency.