Failure to Maintain Annual Clinical Skills Competency Documentation for Nursing Staff
Penalty
Summary
The facility failed to ensure that nursing staff completed annual skills-based competency training, resulting in missing documentation of clinical skills competency for selected staff. During an employee record review on 02/04/2026, the surveyor found that a GNA hired on 01/28/2014 had no evidence of annual clinical skills competency training documentation in the personnel file for the years 2015 through 2024. The same review showed that an RN hired on 06/22/2022 lacked documentation of annual clinical skills training for 2023 and 2024. The facility’s performance evaluation policy, provided to the surveyor, addressed only annual performance evaluations based on job descriptions and did not reference annual clinical skills training. The facility did not provide a policy related to annual clinical training for licensed RNs, LPNs, or GNAs prior to the exit conference. In an interview on 02/04/2025 at 12:00 noon, the DON and HR manager confirmed the absence of skills competency evaluations for the identified staff and stated they were unable to provide proof of such evaluations, and these findings were discussed during the exit conference on 02/04/2026. No resident-specific medical histories or conditions were described in the report, and the deficiency centers on the lack of documented annual clinical skills competency training for nursing staff as identified through administrative record review and staff interviews.
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