Failure to Ensure and Document Consistent RN Coverage
Penalty
Summary
The facility failed to ensure an RN was present in the facility for at least eight consecutive hours a day, seven days a week, for a census of 55 residents. Review of RN time summary sheets from November 2025 through February 2026 showed that eight consecutive hours of RN coverage were documented only on specific, scattered dates within those months, and not consistently throughout the entire period. The interim DON/corporate RN reported they had been serving as the interim DON since the end of October 2025 and were considered the RN coverage for eight consecutive hours per day Monday through Friday, but acknowledged they did not complete time summary sheets or otherwise document their days and times worked in the facility as RN coverage. The administrator confirmed that the interim DON/corporate RN was considered the facility’s eight-hour-a-day RN coverage but stated they could not provide documentation to support that this required RN coverage was actually provided.
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