F0727

F

Failure to Maintain a Full-Time RN Director of Nursing

Fresno, California Survey Completed on 03-25-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to have a full-time Registered Nurse (RN) designated as the Director of Nursing (DON), as required by federal and state regulations and the facility’s own policy. Interviews with the administrator and multiple nursing staff confirmed that the previous DON, an RN, resigned and her last day was 3/6/26, and no interim or acting DON had been appointed since that time. The administrator, who had been in the role for eight days, acknowledged that the facility did not have a DON or interim DON, that the DON position was only posted and they were actively recruiting, and that it is a regulatory requirement to have a full-time DON onsite. The facility census at the time was 71 residents.

Multiple staff members, including RNs, LVNs, and the MDS Coordinator, consistently reported that there was no DON or acting DON in place. Staff described relying on RNs on their shifts, a corporate RN available by phone and visiting intermittently, and an LVN Director of Staff Development for staffing and clinical questions, but none of these individuals were designated as DON. One LVN reported that there were RNs on the day and evening shifts but no RN on the night shift. Review of the facility’s policy on Director of Nursing Services stated that nursing services are under the direct supervision of an RN DON employed full-time (40 hours per week) and responsible for managing nursing services, overseeing licensed nurse schedules, and ensuring care and documentation are in accordance with assessments and care plans. Professional references reviewed by surveyors confirmed the regulatory requirement for a full-time RN DON. The MDS Coordinator stated that without a DON or acting DON, there could be a potential risk of medication errors, improper resident assessment, and non-compliance with facility policies and procedures.