Failure to Ensure Timely Employee Health Examinations for New Hires
Summary
The facility failed to ensure that newly hired employees received a required health examination by a physician, advanced practice nurse, or New Jersey licensed physician assistant within two weeks prior to employment or upon employment, or within thirty days if a registered nurse assessment was completed upon hire. During a review of 10 randomly selected newly hired employee files, it was found that 6 did not have documentation of a completed physical examination as required by regulation. Specifically, one LPN had no pre-employment health screen or documentation of a physical, and other staff had only partial or incomplete health reports. Interviews with the Director of Nursing (DON) confirmed that the facility's process was to have new hires receive a physical 1 to 2 weeks prior to starting work, typically performed by the facility's medical director. Upon review of the files, the DON acknowledged the missing or incomplete documentation and was unable to provide additional information to demonstrate compliance. The facility's policy also required a health review and physical examination for all new employees, but the records reviewed did not consistently meet these requirements.
Plan Of Correction
Element #1. On 6/5/2025 The facility Human Resource Manager (HR), Administrator and Director of Nursing began an audit on all new hire within the last (1) year to schedule date for each new hire to complete a Register Nurse (RN) assessment or physical examination. The Facility Administrator in-serviced on 6/6/2025 the director of nursing to follow the facilitys policy on completing an Registered Nurse assessment upon prior to hire date and schedule health physician exam with the facilitys medical director for all new employees in the required time frame. Element #2. All residents have the potential to be affected by this deficient practice by not completing registered nursing assessment or physician assessment within the required time frame. Element #3. The Administrator on 6/20/2025 met with the Facility Medical Director and Human Resources Manager and Director of Nursing, in-service education the facilitys policy on the timely completion of all new hire health history and physicals within the required time frame. Element #4. The Administrator and the Director of Nursing will monitor and review on a weekly basis for 3 months (from 6/5/25 till 9/5/25), the monthly log for all new hire health history and physical to ensure compliance. The Nursing Director, Human Resources and the Administrator will review the results of these audits, including any actions taken for correction. All findings will be reported at the next two quarterly QAPI meeting. Element #3. The Administrator on 6/20/2025 met with the Facility Medical Director and Human Resources Manager and Director of Nursing, in-service education the facilitys policy on the timely completion of all new hire health history and physicals within the required time frame. Element #4. The Administrator and the Director of Nursing will monitor and review on a weekly basis for 3 months (from 6/5/25 till 9/5/25), the monthly log for all new hire health history and physical to ensure compliance. The Nursing Director, Human Resources and the Administrator will review the results of these audits, including any actions taken for correction. All findings will be reported at the next two quarterly QAPI meeting.
Penalty
The facility failed to ensure that 9 out of 10 newly hired employees received the required health examinations within the specified time frame. These employees did not receive an examination by a physician or advanced practice nurse within two weeks of employment, nor did they receive a nursing assessment on their first day to defer the examination. The DON could not provide evidence of compliance, and no policy for new hire health examinations was available.
Deficiency in New Hire Health Examinations
Penalty
Summary
The facility failed to comply with the mandatory infection control and sanitation requirement by not ensuring that newly hired employees received a health examination within the required time frame. Specifically, 9 out of 10 new employees did not receive an examination by a physician or advanced practice nurse within two weeks prior to their first day of employment or upon employment. Additionally, these employees did not receive a nursing assessment by a registered professional nurse on their first day of employment, which would have allowed for a deferral of the examination for up to 30 days. The Director of Nursing was unable to provide evidence of the required health examinations for these employees, and no facility policy and procedures for new hire health examinations were available to the surveyor.
Plan Of Correction
1. Corrective Action of Areas Affected: The facility cannot retroactively correct the identified concerns related to new hires no longer employed by the facility who did not receive a NJ Ex Order 26.4b1 in accordance to Federal/State regulations. The Staffing Coordinator/HR was re-inserviced on ensuring new hires obtain a health history/physical in accordance with federal and State regulations. 2. Other Areas Affected: All residents have the potential to be affected by this deficient practice. The facility conducted an audit of all employee files to verify the required health history/physical is present. Those identified in need will be obtained. 3. Systemic Changes to Prevent Future Occurrences: A new hire checklist has been implemented including health history/physical and other necessary information required upon employment. The Staffing Coordinator/HR is ensuring the required health history/physical has been obtained prior to employees beginning Orientation. 4. Monitoring of Corrective Action: The Staffing Coordinator/HR will complete an audit weekly x4 weeks, then monthly x2 months of new hires to verify the required health history/physical has been obtained prior to employees beginning Orientation. Results of the audits will be reported at the monthly Quality Assurance Improvement Meetings for review and recommendations.
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