DON Inappropriately Used as Charge Nurse at High Census
Penalty
Summary
The deficiency involves the facility’s failure to ensure that the Director of Nursing (DON) did not serve as a charge nurse when the facility’s average daily census exceeded 60 residents, as required by 10 NYCRR 415.13(b)(1). The DON job description stated that the DON was responsible for planning, directing, and coordinating nursing services, managing resident care 24 hours a day, seven days a week, and ensuring a sufficient number of qualified supervisory and supportive nursing personnel on each tour of duty. Census reports showed that during the review period the facility census ranged from 113 to 116 residents, and at survey entrance the census was 115 out of 135 beds. Despite this census level, daily staffing sheets from late January to mid-February documented that the DON was counted in the facility’s minimum staffing numbers for direct resident care. On specific evening shifts, the DON worked on a named unit from 6:00 PM to 10:00 PM as the second nurse, and on one of those dates, from 9:21 PM to 10:00 PM, the DON was the only nurse on the unit. The facility’s minimal staffing document required two nurses on that unit for the day and evening shifts, and the DON was used to meet those minimums. In interviews, the Facility Scheduler stated they were unaware that the DON was not supposed to act outside the DON role and acknowledged that the DON was used as staff when coverage could not be found, noting that the minimum staffing numbers were not ideal for completing work and providing good care. The DON reported not knowing the exact regulation, believing the practice was merely frowned upon, and stated they frequently acted as a CNA, housekeeper, or medication nurse while remaining available as DON. The Administrator confirmed that minimum staffing numbers were not the goal and that leadership was willing to help staff and residents when needed.
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