F0728

E

Uncertified Nurse Aides Providing Independent Direct Care and Working Beyond Four-Month Limit

Chico, California Survey Completed on 01-06-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that uncertified nurse aides (NAs) in training did not provide direct, hands-on resident care without supervision by a certified nursing assistant (CNA) or licensed nurse, and failure to ensure NAs did not work beyond four months without state certification. Facility documents showed an approved Nurse Aide Training Program (NATP) and a hiring policy requiring compliance with CDPH regulations, as well as a job description stating NAs could not perform direct resident care until theory and clinical skills were completed and competency demonstrated. Despite this, review of CNA/NA employee lists, daily assignments, and the California Nurse Aide Registry revealed multiple NAs who were hired, graduated from NATP, and then assigned to provide direct resident care independently before they were state certified.

Record review showed that several NAs (identified as NA 1, NA 2, NA 3, NA 4, NA 5, and NA 6) were scheduled on various shifts to work independently, unpaired with a CNA, providing direct resident care such as routine daily care and 1:1 observation. Some of these assignments occurred immediately after graduation from NATP but before certification, and others occurred while the aides remained uncertified for extended periods. One NA (NA 4) graduated from NATP and was hired on the same date and remained uncertified months later while being assigned to independent direct care and to accompany residents to appointments. Another NA (NA 3) was hired early in the year and did not become certified until many months later, yet was assigned to independent direct care and 1:1 care prior to certification. Additional NAs (NA 7, NA 8, NA 9) were documented as having hire dates and certification dates that exceeded four months, indicating they worked in the facility beyond the four‑month limit without timely certification.

Interviews corroborated that NAs in training were performing direct resident care. A CNA reported being trained through the facility’s NATP and working for several months. An LVN stated that after NAs were “signed off,” they performed direct resident care and CNAs acted as standbys or guides. An NA graduate (NA 2) stated they had recently completed NATP, were waiting to retake the state CNA test, had been working for about two months, and could do everything a CNA could do, including changing, peri care, and ambulating residents. NA 2 acknowledged they were not supposed to provide direct care independently but had done so at times, being only “somewhat watched” by CNAs. The NATP instructor and Director of Staff Development stated that NAs were not supposed to provide direct care without CNA or licensed nurse supervision until certified, but also stated that graduated NAs were hired as NAs in training and did not receive additional competency testing because the program staff were confident in their abilities. The governing body representative later acknowledged oversight responsibility for the NATP and hiring of NAs at the facilities and was unaware that multiple NAs had worked beyond four months without state certification.