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Based on interview and record review, the facility failed to ensure that the Registered Nurse (RN) provided administrative authority and delineation of responsibilities for patient care as evidenced by 6 (Patient #1, #2, #3, #4, #5 and Patient #6) of 10 patients did not have a Nursing Assessment by an RN during every 24-hour period. The policy and procedure clearly stated that the RN was to perform an assessment every 24 hours.

Findings included:

TX00248120

Record review of the Nursing Assessment for Patient #1 dated 05/10/2016 revealed no documentation by an RN of a change in the patient's condition.

Record review of the Nursing Assessments for Patient #2 revealed the following entries:
On 12/09/2016 at 1256, Personnel E, an LVN, completed the assessment.
On 12/09/2016 at 2126, Personnel G, an LVN, completed the assessment.
On 12/10/2016 at 0800, Personnel C, an LVN, completed the assessment.
On 12/10/2016 at 2217, Personnel G, an LVN, completed the assessment.
On 12/11/2016 at 0830, Personnel C, an LVN, completed the assessment.
On 12/11/2016 at 2154, Personnel G, an LVN, completed the assessment.
On 12/12/2016 at 1514, Personnel E, an LVN, completed the assessment. (There was no other assessment done on 12/12/2016.)
On 12/15/2016 at 0830, Personnel C, an LVN, completed the assessment.
On 12/15/2016 at 2343, Personnel D, an LVN, completed the assessment.

Record review of the Nursing Assessments for Patient #3 revealed the following entries:
On 12/13/2016 at 1553, Personnel E, an LVN, completed the assessment.
On 12/13/2016 at 2100, Personnel D, an LVN, completed the assessment.

Record review of the Nursing Assessments for Patient #4 revealed the following entries:
On 06/01/2016 at 1056, Personnel F, an LVN, completed the assessment.
On 06/01/2016 at 2100, Personnel O, an LVN, completed the assessment.
On 05/31/2016 at 1056, Personnel E, an LVN, completed the assessment.
On 05/31/2016 at 2100, Personnel M, an LVN, completed the assessment.
On 05/22/2016 at 1126, Personnel E, an LVN, completed the assessment. (There was no other assessment done on 05/22/2016.)
On 05/21/2016 at 2100, Personnel M, an LVN, completed the assessment.
On 05/21/2016 at 0932, Personnel E, an LVN, completed the assessment.
On 05/20/2016 at 0830, Personnel C, an LVN, completed the assessment.
On 05/20/2016 at 2100, Personnel P, an LVN, completed the assessment.
On 05/19/2016 at 0800, Personnel F, an LVN, completed the assessment. (There was no other assessment done on 05/19/2016.)

Record review of the Nursing Assessment for Patient #5 dated 12/18/2016 at 1900 revealed an assessment by Personnel F, an LVN. Patient #5 was transferred to another facility with no RN assessment.

Record review of the Nursing Assessment for Patient #6 revealed the following entries:
On 12/14/2016 at 0800, Personnel C, an LVN, completed the assessment.
On 12/14/2016 at 2200, Personnel D, an LVN, completed the assessment.

In an interview with the Quality Director (Personnel B) on 12/16/2016 at 1400, she stated:
Two 12-hour nursing assessments are completed within a 24-hour period.
The RN is to perform and document one of the two 12-hour nursing assessments.
An LVN could perform the other 12-hour assessment under the supervision of the RN. She was not aware that there were instances in which the LVN was performing both 12-hour nursing assessments within a 24-hour period.

Record review of the Facility's Policy and Procedure "Plan for the Delivery of Patient Care" dated April 2016 revealed: " IV. Professional Patient Care Staff: Roles and Functions ... RN assessment every 24 hours."