Governing Body Failed to Prevent Uncertified NAs From Providing Independent Resident Care
Penalty
Summary
The deficiency involves the governing body’s failure to provide adequate oversight of facility administration to ensure that nurse aides were properly certified and competent before providing independent resident care. The facility’s operations manual stated that the governing body engages administrative services to develop policies and procedures for management and operations, and that the governing body reviews and confirms adoption of new and updated policies at least annually. The governing body was also to be informed of any deviations from template policies. Despite this framework, a current CNA/NA employee list showed nine uncertified nursing assistants, and the facility’s own NA job description required that NAs be enrolled in a CDPH‑approved Nursing Assistant Training Program and have clinical competency while enrolled. Additional facility documents showed that NAs were not to provide any direct resident care, including observation, vital signs, changing briefs, feeding, transfers, or any direct care at all. However, review of nursing staff assignment sheets over multiple dates showed uncertified NAs were assigned to take vital signs and given resident assignments, sometimes independently and sometimes with CNAs, contrary to the stated restrictions. Specific review of the CNA/NA list against the California CNA registry revealed multiple NAs who were hired, had completed NATP, but were not yet state certified, and were nonetheless assigned to resident care tasks and vital signs, often not paired 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, NA 6, and NA 9, were repeatedly assigned to take vital signs independently on various shifts while still uncertified. Interviews further confirmed that uncertified NAs and NA students were working on PM and NOC shifts and providing direct resident care. The administrator acknowledged that uncertified NAs were and had been working at the facility and stated they were not aware that uncertified NAs and NA students were not allowed to be employed or have clinical training at the facility, noting that the NATP and clinical routines had been established under previous leadership. Uncertified NAs themselves reported providing direct observation for fall‑risk residents, having independent assignments, and sometimes shadowing CNAs only when the CNA chose to demonstrate care tasks. In a later interview, members of the governing body, including the vice president of operations, regional administrator, and chief clinical officer, stated that only one sister facility had an approved NATP, that the governing body assisted administrators and DONs in creating policies and procedures, and that the administrators and governing body were ultimately responsible for ensuring the NATP program and NA hiring followed federal and state regulations, underscoring the lack of effective oversight that led to uncertified NAs providing resident care.
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