F0837

E

Governing Body Failed to Prevent Uncertified Nurse Aides from Providing Independent Care

Chico, California Survey Completed on 01-14-2026

Penalty

No penalty information released

Summary

The deficiency involves the governing body’s failure to provide adequate oversight of the administrator and ensure that nurse aides were properly certified and competent before providing independent resident care. The facility’s operations manual stated that the governing body was legally responsible for establishing and implementing policies and procedures for management and operation of the facility, including appointing an administrator and providing administrative services to develop those policies. The nursing assistant job description specified that uncertified nursing assistants were only to provide routine daily nursing care and services in which they had received clinical instruction and demonstrated competence, and that general direct resident care duties could not be performed until theory and competency skills were accomplished. The job description also required that nursing assistants be enrolled in a state-approved Nurse’s Aide Training Program (NATP) and maintain clinical competency while enrolled.

Record review showed that Facility 3 did not have a CDPH-approved NATP and was not a clinical training site, yet multiple nurse aides in training were hired and scheduled to provide resident care. Several nurse aides (NAs 1, 2, and 3) were hired before they became state-certified CNAs and were assigned to resident care areas, initially to orient with CNAs and later, in some instances, to work independently or provide 1:1 observation or care for specific residents. One aide (NA 4) was hired and remained uncertified for months while being assigned to work independently on a unit without pairing with a CNA. Another aide (NA 5) graduated from NATP but remained uncertified until resignation and was assigned to independent unit work and 1:1 care. Additional aides (NAs 6 and 7) were hired, completed NATP, and remained uncertified as of the survey date.

Interviews confirmed that these nurse aides in training were treated and scheduled as staff providing direct resident care. The Director of Staff Development stated that Facility 3 did not have an approved NATP and was not a clinical training site, and that their knowledge of the NATP was minimal. The DSD also stated that graduated nurse aides could do almost everything a CNA could do, including 1:1 care and accompanying residents to appointments. The scheduler reported that NAs were scheduled full time and placed into CNA rotation slots in advance so they could transition into CNA positions with an established schedule. The accounts payable/payroll clerk confirmed that NAs in training were employees of Facility 3. The governing body’s representative acknowledged responsibility for oversight of the facilities and stated that only Facility 2 had an approved NATP, while Facility 1 and 3 were not approved due to regulatory compliance history, and agreed that NAs should not be feeding and changing residents. These facts demonstrate that the governing body did not ensure compliance with certification and competency requirements before NAs provided independent resident care.