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, as required. Specifically, there was no RN coverage on two reviewed days, with the nurse schedule and time sheets confirming that only licensed vocational nurses (LVNs) were present during those periods. On these days, LVN staff worked extended shifts, including one LVN who worked 25 hours straight due to a lack of relief, and no RN was available to fulfill the required coverage. Interviews with staff revealed that the staffing coordinator, a CNA, was responsible for managing call-ins and attempting to find replacements when nurses called out. On the days in question, an LVN called in with a family emergency, and the scheduled RN subsequently decided not to come in, citing discomfort with being the only nurse on duty and unfamiliarity with passing medications to the residents. Despite efforts to contact other staff and corporate, no RN was secured to cover the required shift, resulting in LVNs covering the floor for extended hours. The facility's own policy required an RN to provide services at least eight hours every 24 hours, seven days a week. Both the administrator and the staffing coordinator acknowledged the absence of RN coverage and the risks associated with staff working beyond their scheduled hours, including exhaustion and potential medication errors. The deficiency was confirmed through review of schedules, time sheets, and staff interviews, all indicating that the facility did not meet the RN coverage requirement on the specified days.