Failure to Maintain Full-Time DON and Required RN Coverage
Penalty
Summary
The facility failed to provide the services of a Registered Nurse (RN) for at least eight consecutive hours per day, seven days a week, and did not have a Director of Nursing (DON) on a full-time basis for a period of time. Review of facility policies and the facility assessment confirmed that the expectation was to have a full-time DON, who is a RN, and to employ RNs for at least eight hours daily, every day of the week. Interviews with the Administrator, DON, LPNs, Social Services Director, Assistant Director of Nursing (ADON), and Administrator in Training (AIT) consistently revealed that the facility was without a full-time DON from the termination of the previous DON until the hiring of the new DON, and that RN coverage for the required hours was not consistently provided. The ADON, who is an LPN, filled in for some DON duties during this period, but was not a RN. Employee records confirmed the gap in DON coverage, with the previous DON terminated and the new DON starting nearly a month later. Staff interviews indicated that during this period, RN coverage was supplemented only occasionally by agency staff, and there were times when no RN was present in the facility for the required hours. Staff would sometimes call the previous DON or a PRN DON for guidance when needed, but this did not meet the requirement for on-site RN coverage or a full-time DON.