Failure to Provide Required RN Coverage
Penalty
Summary
The facility failed to provide the services of a registered nurse (RN) for at least 8 consecutive hours a day, 7 days a week, over a 90-day review period. Specifically, there was no RN coverage on several weekends, and on other weekends, RN coverage was less than 8 hours. Timesheet records confirmed these gaps in RN presence. Interviews with the Director of Nursing (DON) revealed that only one RN regularly worked weekends, and RNs assigned on weekends were not always present in the building unless called. The DON admitted to being unaware of the regulatory requirement for 8 consecutive hours of RN coverage daily and acknowledged it was her responsibility to ensure compliance. The Administrator also stated that ensuring RN coverage was ultimately her responsibility, despite having enough RNs on staff. Further, the facility was unable to provide requested policies regarding staffing, RN coverage, or scheduling, and only a job description for the DON was available. Both the DON and an RN interviewed recognized that certain tasks requiring an RN, such as signing off on baseline care plans, removing midline/PICC catheters, and pronouncing death, could not be performed without proper RN coverage. The lack of documented policies and inconsistent RN scheduling contributed to the deficiency.