§483.35(b) Registered nurse
§483.35(b)(1) Except when waived under paragraph (e) or (f) of this section, the facility must use the services of a registered nurse for at least 8 consecutive hours a day, 7 days a week.
§483.35(b)(2) Except when waived under paragraph (e) or (f) of this section, the facility must designate a registered nurse to serve as the director of nursing on a full time basis.
§483.35(b)(3) The director of nursing may serve as a charge nurse only when the facility has an average daily occupancy of 60 or fewer residents.
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Observations:
Based on review of the facility's job descriptions and interviews with staff, it was determined that the facility failed to ensure the consistent services of a full-time Director of Nursing (35 or more hours a week) in the facility.
Findings include:
The facility's job description for the Director of Nursing (DON), undated, revealed that as a Health Care Director of Services, the DON is entrusted with the responsibility of caring for the facility's residents, families, co-workers, visitors, and all others. The primary purpose of the job position is to plan, organize, develop, and direct the overall operation of the nursing service department in accordance with current federal, state, and local standards, guidelines, and regulations that govern the facility.
Interview with the Regional Nurse Consultant on July 17, 2024, at 11:53 a.m. revealed that she is trying to cover the Director of Nursing position but that she has to work the floor too much and cannot get the Director of Nursing job duties done. She stated that they are in the process of hiring someone, but that person has not started yet. She indicated that there has not been a full-time Director of Nursing for several weeks as she has had to work as a registered nurse on the floor.
Interview with the Nursing Home Administrator on July 17, 2024, at 13:38 p.m. confirmed that the facility is in the process of hiring a Director of Nursing but that currently there is not one. The Regional Nurse Consultant is pulled from that position daily in order to work on the floor.
28 Pa Code 201.3 Definitions.
28 Pa Code 201.14(a) Responsibility of Licensee.
28 Pa. Code 201.18(e)(6) Management.
28 Pa. Code 211.12(b)(c)(d) Nursing Services.
| | Plan of Correction - To be completed: 08/03/2024
1. The facility cannot retroactively correct Director of Nursing's hours.
2. The facility has begun the process of interviewing for the Director of Nursing role. Currently, we have an interim DON in place as of 7/30/2024.
3. The Executive Director has been re-educated that the Director of Nursing is to work 35 or more hours per week.
4. The Executive Director to conduct Quality Improvement (QI) monitoring of the Director of Nursing's hours worked to ensure 35 hours worked weekly X 4 weeks, then once a month as needed. Findings reported to the Quality Assurance Performance Improvement (QAPI) committee and updated as indicated. QAPI monitoring schedule modified based on findings.
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