Failure to Complete Annual Performance Review and Improper Mechanical Lift Transfer
Penalty
Summary
The facility failed to complete a performance review for a nurse aide at least once every 12 months, as required by policy. Review of personnel files showed no documented evidence that the nurse aide had a performance evaluation for the years 2024 and 2025. The Director of Nursing confirmed that there was no process in place for completing performance evaluations for employees, including the nurse aide in question. Additionally, an incident occurred in which a resident fell while being transferred from a wheelchair to a bed using a mechanical lift. The nurse aide performed the transfer alone, contrary to facility policy requiring two staff members for all Hoyer lift transfers. The resident sustained an injury as a result of the fall. Inspection of the mechanical lift sling revealed no issues, and the Director of Nursing confirmed that the injury occurred due to the nurse aide transferring the resident independently.