Failure to Timely Notify State Agency of DON Change
Penalty
No penalty information released
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 notify the State Agency within five working days following a change in the Director of Nursing (DON), as required by licensure regulations. Record review showed that the DON was changed on 9/13/25, but the notification form was not faxed to the Department of Health and Human Services (DHHS) until 9/29/25, exceeding the required timeframe. During an interview, the Administrator confirmed that the notification was not submitted within the mandated five working days. This deficiency had the potential to affect all 68 residents residing in the facility at the time.