Governing Body Failed to Prevent Uncertified Nurse Aides From Providing Independent Direct Care
Penalty
Summary
The governing body failed to provide adequate oversight of the administrator and hiring processes to ensure that nurse aides were state certified and had required competencies before providing independent resident care. Facility operational documents showed that the governing body was responsible and accountable for quality assurance and had engaged administrative services to develop and implement policies, including those related to hiring and employment verification. The hiring policy for one facility stated that the facility was committed to hiring qualified and legally authorized individuals and to following all applicable federal and state regulations, including California Department of Public Health (CDPH) requirements, but this policy was not effectively implemented to prevent uncertified nurse aides from providing direct care. Record reviews of CNA/NA employee lists, daily assignments, and the California Nurse Aide Registry showed that multiple nurse aides in training, who were not yet state certified, were hired and then assigned to work independently providing direct resident care without being paired with a CNA or licensed nurse. Specific examples included several nurse aides who, after graduating from a Nurse Aide Training Program (NATP) but before state certification, were scheduled on various shifts to provide direct resident care such as feeding and changing residents, and in one case to provide 1:1 direct observation care. Some aides worked independently on multiple dates and shifts, and at least one aide remained uncertified for months while continuing to be assigned to independent resident care and to accompany residents to appointments. Additionally, several aides worked beyond four months from hire or NATP graduation before obtaining certification, or remained uncertified until termination. Interviews with the NATP instructor and the director of staff development revealed that the NATP provided 60 hours of theory and 100 hours of clinical training at one facility, and that students were selected and hired across three facilities. The NATP instructor stated that NAs were not supposed to provide direct resident care without supervision until state certified and that graduates were hired as NAs in training. However, they acknowledged that NAs had been providing care somewhat independently, particularly on night shifts, and that they had only recently adjusted assignments for closer observation. They also stated they were unaware that NA graduates were not permitted to work as uncertified NAs at the other two facilities, which did not have NATPs, and confirmed that no additional competency testing was done after hire because they relied on the NATP training. In a separate interview, a vice president of operations confirmed that the governing body oversaw the three facilities and the NATP, that only one facility was an approved NATP site, and acknowledged that NAs should not be feeding and changing residents and that administrators and the governing body were ultimately responsible for ensuring compliance with federal and state regulations regarding NATP and NA hiring.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.