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ENCOMPASS HEALTH REHABILITAITON HOSPITAL OF RICHAR
STAFFING AND DELIVERY OF CARE
Tag No.: A0392
Based on interview and record review the hospital failed to ensure an RN (Registered Nurse) was immediately available for any bedside patient care on 6 (7 AM-7 PM shift on 05/26/15, 08/29/15, 09/04/15, 09/05/15, 09/06/15, 09/15/15) of 12 shifts reviewed.
Findings included:
During an interview on 09/17/15 at 10:15 AM with Personnel #4 she said all House Supervisors were RNs. If there are all LVNs assigned to a shift with no RNs then the House Supervisor has to do the assessments. Admission assessments are done by RNs. Personnel #4 confirmed she couldn't be in 2 places at one time. If an RN was needed immediately at a patient's bedside on the first floor and on the 2nd floor at the same time and she was the House Supervisor assigned to work that shift, she could only be on one floor at a time. Personnel #4 said if the regulations say an RN must be available immediately at a patient's bedside "then that's not what happens on those schedules." Personnel #4 said she sometimes takes patient assignments at the same time she is in the role of House Supervisor.
During an interview on 09/16/15 at 1:30 PM with Personnel #3 and Personnel #2 they were asked how a registered nurse (RN) was able to immediately be available at a patient's bedside when only LVNs were assigned to patient care on 1st and 2nd floors and the only available RN was the House Supervisor. They both suggested they could be available while they were in the hospital. Personnel #2 said she was usually in the hospital and available Mondays thru Fridays from approximately 7:30 AM to 4:00 PM. Personnel #3 said he was usually available and present in the hospital Mondays thru Fridays around 8:00 AM to 5:00 PM. They told the surveyor the nursing staff schedules were from 7:00 AM to 7:00 PM and 7:00 PM to 7:00 AM 7 days a week. They both confirmed that the day shift couldn't be covered for the full 12 hours by either of them on most days Monday through Friday. Personnel #3 and Personnel #2 were shown several staffing schedules that reflected only LVNs were assigned to patient care on the 1st and 2nd floors and the only available RN was the House Supervisor. The surveyor informed them that an RN must be immediately available at a patient's bedside if needed. They both asked if that was a new regulation. The surveyor informed them it was not.
Review of the hospital's assignment sheets for patient care areas on the 1st floor and the 2nd floor revealed the following for the 7 AM-7PM day shifts:
On 05/26/15 the patient census was 8 on the 1st floor and 21 on the 2nd floor. There were no RNs assigned to take care of patients. There were 2 LVNs assigned to the 1st floor and 3 LVNs assigned to the 2nd floor. One RN House Supervisor was assigned to supervise both floors.
On 08/29/15 the patient census was 14 on the 1st floor and 16 on the 2nd floor. There were no RNs assigned to take care of patients. There were 2 LVNs assigned to each floor. One RN House Supervisor was assigned to supervise both floors.
On 09/04/15 the patient census was 15 on the 1st floor and 17 on the 2nd floor. There were no RNs assigned to take care of patients. There were 2 LVNs assigned to each floor. One RN House Supervisor was assigned to supervise both floors.
On 09/05/15 the patient census was 15 on the 1st floor and 13 on the 2nd floor. There were no RNs assigned to take care of patients. There were 2 LVNs assigned to the 1st floor and 2 LVNs assigned to the 2nd floor. One RN House Supervisor was assigned to supervise both floors.
On 09/06/15 the patient census was 15 on the 1st floor and 13 on the 2nd floor. There were no RNs assigned to take care of patients. There were 2 LVNs assigned to each floor. One RN House Supervisor was assigned to supervise both floors.
On 09/15/15 the patient census was 16 on the 1st floor and 16 on the 2nd floor. There were no RNs assigned to take care of patients. There were 2 LVNs assigned to the 1st floor and 2 LVNs assigned to the 2nd floor. One RN House Supervisor was assigned to supervise both floors.
The facility's Staffing Plan dated 11/2014 indicated, " ...The hospital will have a Registered Nurse (RN) Supervisor on each shift. This person may or may not have assigned patients ... There will be RN oversight for all patient care ... The minimal/presumptive staffing level will be a Registered Nurse and a Licensed Practical/Vocational Nurse ..."