F0726

E

Lack of Documented Ventilator/Trach Care Competencies for Nursing Staff

Milwaukee, Wisconsin Survey Completed on 02-17-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure that nurses and nurse aides working on the ventilator unit had the appropriate competencies and skill sets to care for all residents with ventilators and/or tracheostomies. The facility assessment dated February 2026 stated that RN, LPN, and CNA competencies were to be obtained and evaluated through annual skills checks and as-needed training for new or unique skill sets. Despite this, surveyor review of the daily nursing schedule from 1/11/26 to 2/9/26 showed multiple RNs, LPNs, and CNAs regularly assigned to the ventilator unit, where 13 residents with ventilators and/or tracheostomies resided, without documented evidence that these staff had been assessed for competency in ventilator or tracheostomy care.

Record review revealed that only one LPN (LPN-RR) had documentation of an in-service on suctioning and tracheostomy care, dated 3/19/25. None of the other listed staff who worked on the ventilator unit during the review period had documentation of receiving this in-service. When the surveyor requested competencies for facility and agency licensed nurses and CNAs who worked on the ventilator unit between 1/11/26 and 2/9/26, the Nursing Home Administrator initially stated that the facility would not have those competencies and acknowledged that competencies were done only if something came up, and that the facility’s policy did not reflect a requirement to complete competencies for all staff.

The facility’s policy titled "Staffing Designation and Role Assignment," last reviewed 10/21/25, described a standardized approach for staffing designation, including credential verification, orientation, mandatory in-service education, and role assignment consistent with licensure and job description, but did not specify how competency for specialized units such as the ventilator unit would be validated. In interviews, the NHA stated that staff were allowed to work on the ventilator unit based on formal orientation, perceived strength, and past work history, such as prior acute care experience. The ADON reported that in-services were provided for issues such as abuse allegations, new processes, or changes in orders, but was unsure who was responsible for competencies and stated she had not done any. When the NHA later indicated that competencies had been done about a year ago and was asked again to provide competencies for nursing staff who worked on the ventilator unit, no such documentation was provided to the surveyor.