Other·September 28, 2023

42 CFR §483.35(b) Registered nurse §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. On 8/21/2023, the California Department of Public Health (CDPH) made an unannounced visit to the facility to investigate a complaint about residents’ rights. The facility failed to ensure a Registered Nurse (RN) was on duty for at least eight consecutive hours a day, seven days a week on 6/3/2023, 6/4/2023, 6/11/2023, 6/17/2023, and 6/25/2023. As a result, all residents (52 bed capacity) in the facility were placed at high risk of receiving inadequate care and not meeting the residents’ needs. On 8/21/2023, a review of the facility’s RNs and Licensed Vocational Nurses (LVNs) monthly schedule for 6/2023, indicated there was no RN coverage for at least 8 hours a day for a total of five days: 6/3/2023, 6/4/2023, 6/11/2023, 6/17/2023, and 6/25/2023. A review of the Nursing Staffing Assignment and Sign-In Sheet, dated 6/1/2023 to 6/30/2023, indicated there was no RN signed-in on 6/11/2023, 6/17/2023, 6/20/2023, and 6/25/2023. For 6/3/2023, the Sign-in Sheet indicated that RN 1’s shift started at 11:45 a.m. and ended at 4:05 p.m. (a total of 4.20 hours). For 6/4/2023, the Sign-In Sheet indicated that RN 1’s shift started at 2 p.m. with no end of the shift documented. The Sign-In Sheet for 6/20/2023 day shift (7 a.m. to 3 p.m.) was not provided. A review of RN 1’s timecard, from 6/1/2023 to 6/30/2023, indicated RN 1 worked 4.37 hours on 6/3/2023 and 3.57 hours on 6/4/2023. RN 1 did not have a timecard data from 6/20/2023 to 6/30/2023. On 8/21/2023 at 3:23 p.m., during a concurrent interview with the Director of Nursing (DON) and review of the RNs and LVNs monthly schedule from 6/2023 to 8/2023, the DON stated there were no RNs on schedule or worked for at least 8 consecutive hours a day on 6/3/2023 (Saturday), 6/4/2023 (Sunday), 6/11/2023 (Sunday), 6/17/2023 (Saturday), and 6/25/2023 (Sunday). The DON did not provide documented evidence that during the above-mentioned days there was a RN or the DON worked for eight consecutive hours. On 8/21/2023 at 3:28 p.m., during an interview, the Administrator (ADM) stated he was not aware there were days with insufficient or no RN coverage for 6/2023. The ADM stated the previous DON was no longer working at the facility since 6/2023. The previous DON’s timecard was not provided. The ADM stated that they did not have a policy on RN staffing. The ADM did not provide documented evidence that on 6/3/2023, 6/4/2023, 6/11/2023, 6/17/2023, and 6/25/2023, there was a RN, or the DON worked for eight consecutive hours. The facility failed to ensure a RN was on duty for at least eight consecutive hours a day, seven days a week on 6/3/2023, 6/4/2023, 6/11/2023, 6/17/2023, and 6/25/2023. As a result, all residents (52 bed capacity) in the facility were placed at high risk of receiving inadequate care and not meeting the residents’ needs. The above violation had a direct relationship to the health, safety, or security of all the residents in the facility.