Lack of Competent and Authorized Nursing Staff for Medication-Related Tasks and Missing Competency Assessments
Penalty
Summary
The deficiency involves the facility’s failure to ensure that nurses and LNAs possessed and demonstrated appropriate competencies for resident care, including medication-related tasks. State statutes require that nursing assistants be licensed and, to administer medications in a nursing home, complete a Board‑approved medication administration program, pass an examination, and be endorsed by the Board as medication nursing assistants. For one resident with an order for 4% lidocaine patches to be applied to both hips at bedtime for 12 hours on and 12 hours off, the assigned nurse stated that LNAs remove the lidocaine patches, but no LNA had reported patch removal to the nurse. During observation, the nurse entered the resident’s room to administer oral medications and did not check for or remove the lidocaine patches before or after medication administration. Review of the facility’s LNA job description showed no mention of assisting with medication administration, and review of training and competency records for five sampled LNAs revealed no training regarding medication administration or assisting with medication administration. The Administrator confirmed that no LNAs in the facility were certified or trained to assist with medication administration, including removal of lidocaine patches. The deficiency also includes a lack of documented competency assessments for nursing staff. Review of employee training and competency files showed that an RN hired in mid‑December had no proof that the facility had assessed her skills competency, even though she was already working shifts. Additionally, one of five LNA files reviewed contained no proof of completed competency assessments for two consecutive years and no evidence of related training. The DON reported that new staff are given a packet of competencies to complete with a preceptor and then return, but confirmed that the RN had not yet submitted her competencies and that the LNA had no competency documentation for the specified years.
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