Failure to Maintain Required Daily RN Coverage
Penalty
Summary
The deficiency involves the facility’s failure to ensure that a Registered Nurse (RN) was on duty for at least eight consecutive hours per day, seven days a week, as required. Review of the Payroll Based Journal (PBJ) reports for the federal fiscal third and fourth quarters of 2025 showed days without the required RN coverage. Daily census posting sheets from April through September 2025 documented a consistent census of fewer than 60 residents and confirmed that on multiple specific dates there was no RN coverage for eight consecutive hours. Daily nursing staffing sheets for the same period also showed that no RN was scheduled for at least eight consecutive hours on those dates, and timecard records confirmed that no RN actually worked eight consecutive hours on those days. During an interview, the Administrator stated she was responsible for ensuring that an RN was scheduled to work eight consecutive hours each day and acknowledged ongoing difficulties in maintaining this required coverage since she began her role. She reported that the facility relied on agency nurses to fill RN shifts, and when an agency RN did not report for a scheduled shift, she was often unable to secure a replacement. She also noted that the previous Director of Nursing was unavailable during these times, which contributed to the gaps in the required RN coverage.
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