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Based on observation, staffing assignment review and interview, it was determined the facility failed to staff with an adequate number of Registered Nurses (RN) in that each unit was not staffed with an RN for 15 of 15 (09/07/23 through 09/20/23) days reviewed. The failed practice did not ensure an RN was immediately available for the care of any patient. The failed practice had the likelihood to affect all patients admitted to the facility. Findings follow:

A. Observation on 09/21/23 at 2:30 PM showed the Hickory and Magnolia Unit had its own nursing station. The nursing stations were separated by a wall with a closing door. The patient care areas of the Hickory and Magnolia units were separated by a closed door.
B. Observation on 09/21/23 at 2:30 PM showed the two units were staffed by RN #1 and Licensed Practical Nurse (LPN) #1. RN #1 was the only RN staffed for the Hickory and Magnolia Units.
C. In an interview with RN #1 on 09/21/23 at 2:30 PM, she confirmed she was the only RN that was staffed for both the Hickory and Magnolia Units.
D. Review of the staffing sheets from 09/07/23 to 09/20/23 showed there was only one RN scheduled for the following shifts:
1) 09/07/23: 7 AM to 7 PM shift and 7 PM to 7 AM shift
2) 09/08/23: 7 AM to 7 PM shift
3) 09/09/23: 7 AM to 7 PM shift and 7 PM to 7 PM shift
4) 09/10/23: 7 AM to 7 PM shift and 7 PM to 7 PM shift
5) 09/11/23: 7 AM to 7 PM shift and 7 PM to 7 PM shift
6) 09/12/23: 7 AM to 7 PM shift and 7 PM to 7 PM shift
7) 09/13/23: 7 AM to 7 PM shift and 7 PM to 7 PM shift
8) 09/14/23: 7 PM to 7 AM shift
9) 09/15/23: 7 PM to 7 AM shift
10) 09/16/23: 7 AM to 7 PM shift
11) 09/17/23: 7 AM to 7 PM shift
12) 09/18/23: 7 AM to 7 PM shift
13) 09/19/23: 7 PM to 7 AM shift
14) 09/20/23: 7 AM to 7 PM shift
E. The findings of A, B and D were confirmed in an interview with the Chief Nursing Officer on 09/21/23 at 3:10 PM.

Based on medical record review, policy and procedure review and interview, it was determined the facility failed to ensure Registered Nurse (RN) supervision and evaluation of nursing care in that three (#2, #4 and #7) of seven (#1-#7) patients did not have a shift assessment conducted by an RN each shift. The failed practice did not ensure the RN assessed the patients and supervised and evaluated care provided by other staff members. The failed practice had the likelihood to affect all patients admitted to the facility. Findings follow:

A. Review of the facility's policy titled, "Nursing Reassessment," with a revision date of 11/2020, showed reassessment of the patient's needs was to be assessed by an RN and more frequently as is contingent on the urgency of the patient's condition. The RN assesses the patient, with input from the LPN (Licensed Practical Nurse) and Psychiatric Technician regarding observations of the patient. Any documented observations performed by the LPN in regard to shift assessment must be verified and signed by the RN.
B. The findings of A were confirmed in an interview with the Chief Nursing Officer on 09/21/23 at 10:45 AM.
C. Review of Patient #2's clinical record showed there was no evidence of an RN assessment on 08/11/23 from 7 AM to 7 PM.
D. Review of Patient #4's clinical record showed there was no evidence of an RN assessment or showed an RN cosigned behind an LPN as follows:
1) On 07/03/23 from 7 AM to 7 PM
2) On 07/10/23 from 7 AM to 07/11/23 at 7 AM
3) On 07/11/23 from 7 AM to 07/12/23 at 7 AM
4) On 07/12/23 from 7 PM to 07/13/23 at 7 AM
5) On 07/13/23 from 7 PM to 07/14/23 at 7 AM
6) On 08/03/23 from 7 AM to 7 PM
7) On 08/07/23 from 7 PM to 08/08/23 at 7 AM
8) On 08/22/23 from 7 AM to 08/23/23 at 7 AM
9) On 08/24/23 from 7 AM to 08/25/23 at 7 AM
10) On 08/25/23 from 7 AM to 7 PM
11) On 08/26/23 from 7 AM to 08/27/23 at 7 AM
E. Review of Patient #7's clinical records showed there was no evidence of an RN assessment or showed an RN cosigned behind an LPN as follows:
1) On 08/02/23 from 7 AM to 7 PM
2) On 08/24/23 from 7 AM to 08/25/23 at 7 AM
3) On 08/25/23 from 7 AM to 08/26/23 at 7 AM
4) On 08/28/23 from 7 AM to 08/29/23 at 7 AM
5) On 08/29/23 from 7 AM to 08/30/23 at 7 AM
6) On 08/30/23 from 7 AM to 08/31/23 at 7 AM
7) On 08/31/23 from 7 AM to 09/01/23 at 7 AM
F. The findings of C, D and E were confirmed in an interview with the Chief Nursing Officer on 09/22/23 at 10:45 AM.