Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the required services of a Registered Nurse (RN) for at least 8 consecutive hours per day, 7 days a week, as mandated. Observations and record reviews revealed that there was no RN coverage on multiple dates, specifically from 8/11 to 8/15, 8/18 to 8/22, 8/25 to 8/28, and on 9/1 and 9/2. The Daily Nurse Staffing Reports and interviews with staff confirmed that there were zero scheduled RN hours on these dates, despite the facility having a census of 72 residents. The Director of Nursing (DON) and other staff members were unaware that the DON's hours could not be used to fulfill the RN staffing requirement when the average daily census exceeded 60 residents. The facility did not have any other RNs scheduled to cover the required hours during the identified periods, and the RN who typically provided coverage was out on leave and not replaced. Interviews with the DON, staffing coordinator, and administrator revealed a lack of understanding regarding the RN coverage requirements, particularly that the DON's hours could not be counted toward the mandated RN coverage when the census was above 60. The facility's own policy stated that a RN must provide services at least eight hours every 24 hours, seven days a week, and that the DON may only serve as charge nurse if the average daily occupancy is 60 or fewer residents. Despite this, the facility relied solely on the DON's hours and did not ensure additional RN coverage, resulting in noncompliance with federal staffing requirements.