Ensure that nurse aides who have worked more than 4 months, are trained and competent; and nurse aides who have worked less than 4 months are enrolled in appropriate training.
of F728 citations were written at actual harm or above. The mark is the share across all tags, 5.4%.
Citations in 202571
Every F728 citation surveyors wrote nationally that year.
Facilities cited68
Distinct nursing homes with at least one F728 finding.
The harm level
How severely F728 is cited
1.1% of citations found actual harm or worse (level G and above).
Citations by CMS scope and severity. Rows are harm level, columns are how widespread the finding was.
Severity
Isolated
Pattern
Widespread
Immediate jeopardy
J10.4%
K—
L20.7%
Actual harm
G—
H—
I—
No harm, potential for more than minimal
D12142.6%
E12243.0%
F3713.0%
No harm, potential for minimal
A—
B—
C10.4%
Every recorded F728 citation, by the harm level and scope the surveyor assigned.
In the surveyor’s words
What an F728 citation says
One finding from each severity level, most serious first.
Severity is as the surveyor wrote it. Some findings had already been corrected before the survey.
L · Immediate jeopardy, widespreadMay 30, 2025
Refer F 835
Based on interviews and a review of pertinent facility documents, it was determined that the facility failed to ensure that a.) a non-certified Nursing Aide (NA#1) received the required training and competencies needed prior to receiving their own assignment and rendering resident care which included but not limited to; bathing, toileting, transferring, feeding, personal hygiene, and grooming and b.) NAs did not work past 120 days without being certified as a nursing aide. This deficient practice was identified for 2 of 3 NAs reviewed (NA#1 and NA#2) who provided direct care to residents on 4 of 4 nursing units.
NA#1 was hired on 9/16/24, to provide care to the residents. …
E · No harm, potential for more than minimal, patternSeptember 3, 2026
Based on review of staffing schedules, personnel files, and staff interviews, it was determined the facility failed to ensure full-time employees working as a nurse aide successfully complete a State approved training and competency evaluation program within 4 months of being hired. This was true for 2 of 3 nurse aides (NA #1 and #2) whose personnel file was reviewed. This failure had the potential to result in negative outcomes for all residents living in the facility. Findings include:Nurse Aide #1 started employment with the facility on 4/30/26.On 9/2/26, Nurse Aide #1's personnel file documented she had registered for a CNA State approved training on 8/28/26 but had not completed the CNA State approved training and competency evaluation program within 4 months of being hired. …
C · No harm, potential for minimal, widespreadNovember 22, 2023
Based on observation, interview and review of pertinent facility documents, it was determined that the facility failed to ensure: a.) verification that recently hired non-certified Nursing Aides (NA) were currently enrolled and actively taking classes in a New Jersey state-approved Certified Nursing Aide (CNA) Training Program, b.) validate completion of Module 1 in their CNA Training Program prior to allocating an independent resident assignment, and c.) there was a delineated policy and/or program in place for the hiring, staffing, and assignments of non-certified NAs for one (1) of one (1) non-certified NA's. …
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