F0728

E

Uncertified Nurse Aides Providing Independent Resident Care Without Approved Training

Chico, California Survey Completed on 01-06-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that nurse aides (NAs) who had worked more than four months were trained and competent, and that NAs who had worked less than four months were properly enrolled in an approved training program before providing direct resident care. Facility 1 did not have a California Department of Public Health (CDPH)-approved Nursing Assistant Training Program (NATP), yet employed multiple uncertified NAs identified as "INS-Staff Training Aides." The facility’s own NA job description required enrollment in a CDPH-approved NATP and clinical competency, and an internal "Can and Can't Do" list stated that NAs could not perform any direct resident care, including observation, vital signs, changing briefs, feeding, or transfers. Despite these written expectations, surveyors’ review of staffing records and schedules showed that uncertified NAs were assigned to resident care tasks and vital signs, often independently and without required pairing or supervision by a CNA.

Record review of the CNA/NA list and the California CNA registry showed that several NAs were hired, graduated from NATP at another facility, and either remained uncertified or were not yet certified during the time they were assigned resident care duties. For example, NAs were documented as taking vital signs independently on various shifts and being given resident assignments, sometimes after only brief orientation or partial shadowing with a CNA. Some NAs, such as NA 3, were assigned independent resident assignments on night shift before certification, and others, such as NA 5 and NA 6, were repeatedly assigned to take vital signs independently without being paired with a CNA. Interviews with CNAs confirmed that student NAs from the NATP were often hired and then assigned to units working independently rather than strictly shadowing, and that there were many new staff working under these conditions.

Interviews with facility leadership and NAs further substantiated that uncertified NAs were providing direct resident care and observation. The Director of Staff Development acknowledged that only Facility 2 had an approved NATP and that NAs for Facility 1 were selected jointly by Facilities 1, 2, and 3, then oriented and paired with CNAs for competencies, but the assignment sheets showed that this pairing did not consistently occur. The Administrator admitted that uncertified NAs had been working on PM and NOC shifts and stated they were unaware that uncertified NAs and NA students were not allowed to be employed or have clinical training at Facility 1. Uncertified NAs themselves reported providing direct observation for fall-risk residents, having independent assignments, and occasionally performing hands-on care when residents were in need, despite still waiting for state certification numbers. The Governing Body representatives confirmed that only Facility 2 was approved for NATP, that Facility 1 and 3 were not approved due to regulatory history, and agreed that NAs should not be feeding and changing residents, while acknowledging their responsibility for oversight of policies and hiring practices across the three facilities.