Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours a day, seven days a week, as required. During a 30-day review period, there were five days when no RN was on duty for the minimum required hours. Review of timecard punches and staffing grids confirmed that on these dates, RN coverage was insufficient, with some days showing only partial RN presence and others lacking any RN time punches. The Director of Nursing (DON), Assistant Director of Nursing (ADON), and Infection Preventionist (IP), all of whom are RNs, did not consistently have time punches or provide direct resident care during these periods. The facility was unable to provide requested documentation, including the facility assessment, staffing policy, and daily staffing posts for the previous 30 days. Interviews with staff revealed that RN coverage was often provided by the DON and ADON, but the exact amount of time and consistency of this coverage was unclear. Staff also indicated that RN coverage was sometimes lacking on weekends. The IP and ADON confirmed they did not provide direct resident care, and the DON stated that there were multiple RN vacancies and that agency RNs were used to attempt to fill shifts. The Regional Nurse's hours could not be verified, and the Administrator was unavailable for interview. The facility census at the time was 115 residents, all of whom had the potential to be affected by the lack of required RN coverage.