DIRECTOR SNF

Position SummaryUnder the general direction of the Chief Nursing Officer, and subject to the administrative oversight of the District’s designated Skilled Nursing Facility Administrator, the Director of Nursing Services has written administrative authority, responsibility, and accountability for nursing services within the Distinct Part Skilled Nursing Facility. The Director plans, organizes, develops, implements, directs, evaluates, and continuously improves resident nursing care in accordance with each resident’s needs, practitioner orders, the interdisciplinary care plan, professional standards, District policy, and applicable federal and California requirements.The Director is accountable for resident outcomes, sufficient and competent staffing, clinical practice, quality assurance and performance improvement, survey readiness, infection prevention, antibiotic stewardship, workforce development, fiscal stewardship, and a safe, respectful environment. This position serves only the Distinct Part Skilled Nursing Facility as Director of Nursing Services at any one time, as required by California law.Organizational CommitmentMissionJohn C. Fremont Healthcare District’s mission is to provide high-quality, compassionate, and accessible healthcare close to home. Every Teammate is expected to support this mission through professional, responsive, and person-centered service.VisionJohn C. Fremont Healthcare District’s vision is to be a leader in rural healthcare. Teammates contribute to this vision by supporting safe, reliable, innovative, and sustainable healthcare services for the communities we serve.PEAKS ValuesAll Teammates are expected to demonstrate the District’s PEAKS values in their daily work:Person-Centered: Place patients, residents, families, and Teammates at the center of our decisions and actions.Engage: Communicate openly, collaborate effectively, and actively participate in improving the District.Accountable: Take ownership of responsibilities, decisions, conduct, and outcomes.Kindness: Treat every person with dignity, compassion, patience, and respect.Serve Others: Support the needs of our patients, residents, community, and fellow Teammates.Culture of SafetyEvery Teammate shares responsibility for maintaining a Culture of Safety. Teammates are expected to identify and promptly report safety concerns, errors, near misses, hazards, and opportunities for improvement through the appropriate reporting and chain-of-command processes. Teammates must participate honestly and constructively in safety reviews, protect patients and residents from harm, follow established safety practices, and support an environment in which concerns may be raised without fear of retaliation.Just CultureJohn C. Fremont Healthcare District applies Just Culture principles when reviewing workplace decisions, conduct, performance, and safety events. The District distinguishes among human error, at-risk behavior, and reckless behavior while considering system factors, available resources, training, policies, and individual accountability. Teammates are expected to make responsible choices, follow established policies and procedures, report concerns accurately, participate in improvement efforts, and accept appropriate accountability for their actions and decisions.Essential Duties and ResponsibilitiesResident Care and Clinical OperationsDirect nursing services so each resident receives necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being consistent with the comprehensive assessment, person-centered care plan, resident choices, and professional standards.Ensure registered nurse oversight of assessment, care planning, supervision, implementation, evaluation, documentation, and resident advocacy; delegate or assign care only within lawful scope of practice and validated competency.Ensure timely and accurate completion of admission assessments, Minimum Data Set processes, care-area assessments, baseline and comprehensive care plans, significant-change reviews, quarterly reviews, progress documentation, transfer and discharge documentation, and required notices.Coordinate with the MDS nurse/coordinator and interdisciplinary team to verify MDS assessment scheduling, completion, accuracy, submission and correction through iQIES, and the use of assessment findings in individualized care planning; escalate overdue assessments and unresolved validation errors.Maintain reliable systems for practitioner orders, medication administration, change-of-condition assessment and notification, laboratory and diagnostic follow-up, emergency response, transfer, return, and continuity of care.Direct clinical programs including falls prevention, skin and wound care, pressure injury prevention, restorative nursing, pain management, restraint reduction, nutrition and hydration, bowel and bladder management, behavioral health support, and end-of-life care.Protect resident dignity, privacy, autonomy, informed choice, visitation, grievances, access to records, freedom from abuse, neglect, exploitation, involuntary seclusion, and improper use of restraints.Ensure resident transfers and discharges, bed-hold notices, admissions, and grievances are managed with required resident/representative notification, documentation, appeal rights, and interdisciplinary coordination.Staffing Supervision and CompetencyProvide general nursing oversight of Ewing Wing’s CDPH-approved Nurse Assistant Training Program in accordance with the District’s approved program structure. Oversee the approved DSD/instructor, monitor implementation of the approved curriculum and training schedule, review instructor performance, and verify that student training and competency records support required completion attestations. Complete applicable CDPH attestations when serving as the designated program official. Coordinate with Human Resources and District administration to maintain current program approvals, personnel designations, job descriptions, organizational charts, and required submissions when program staffing or operations change. The facility Director of Nursing does not provide the actual NATP theory or clinical instruction.Ensure sufficient numbers of qualified nursing personnel are scheduled and available on every shift based on the facility assessment, resident acuity, care plans, census, competencies, and all applicable federal and California staffing requirements.Maintain a staffing matrix reflecting actual resident care needs and competencies, applicable distinct-part SNF staffing requirements, and the current facility assessment; promptly escalate staffing deficits and document mitigation actions.Oversee daily nurse staffing postings, retention of staffing records, and reconciliation of payroll, agency, and scheduling records to support accurate, auditable Payroll-Based Journal (PBJ) submissions in coordination with the responsible reporting department.Maintain the Director of Nursing Services schedule of eight hours per day on the day shift, five days per week, consistent with 22 CCR §72327; ensure federal RN coverage for at least eight consecutive hours each day, seven days per week, except to the extent expressly authorized by an applicable, current federal waiver. Document and monitor any waiver conditions, renewal dates, required notices, and alternate clinical coverage. The Director may serve as charge nurse only when permitted by 42 CFR §483.35(b)(3) and consistent with resident safety and operational needs.Designate in writing a qualified licensed nurse to act in the Director’s absence and maintain clear 24-hour nursing supervision, escalation, and chain-of-command processes.Maintain a documented nursing-leadership succession and escalation plan for weekends, holidays, absences, and emergencies, including accountability for shift-to-shift handoff and timely response to changes in resident condition.Oversee recruitment, selection, orientation, competency validation, scheduling, attendance, performance evaluation, coaching, corrective action, and professional development in collaboration with Human Resources.Verify and monitor licenses, certifications, health clearances, background requirements, competencies, and mandatory education; promptly remove or restrict any assignment when credentials or competence do not support safe, lawful practice.Ensure registry and agency personnel are screened, oriented, competency-validated, supervised, and evaluated consistent with District policy and applicable requirements.Partner with the Director of Staff Development to ensure new-hire, annual, dementia-care, abuse-prevention, emergency, infection-control, resident-rights, and role-specific education is completed and documented.Ensure nurse aide training, certification verification, competency, supervision, and any District-operated Nursing Assistant Training Program coordination comply with applicable CDPH approvals and federal and California requirements.Quality Assurance Compliance and Survey ReadinessLead nursing participation in the facility’s Quality Assurance and Performance Improvement program, Quality Assessment and Assurance Committee, facility assessment, risk management, and resident-safety activities.Coordinate annual and material-change updates to the facility assessment with the Administrator and interdisciplinary leadership, including acuity, resident population, staffing competencies, resources, and emergency preparedness; apply the findings to nursing staffing and service planning.Implement a documented QAPI follow-up process identifying corrective actions, accountable owners, due dates, effectiveness measures, and evidence of sustained compliance; escalate recurring or unresolved clinical risks to the Chief Nursing Officer and QAA Committee.Review 24-hour reports, incidents, falls, medication events, infections, pressure injuries, weight change, hospital transfers, grievances, consultant reports, staffing data, and other indicators; identify trends and implement sustainable corrective action.Maintain continuous readiness for CDPH and CMS surveys, complaint investigations, audits, and monitoring visits; coordinate nursing responses, evidence, plans of correction, and sustained compliance.Oversee nursing follow-up to survey deficiencies, complaints, and plans of correction, including staff education, competency validation, monitoring, documentation, and evidence of correction within required deadlines.Develop, review, implement, and monitor nursing policies and procedures consistent with resident needs, professional standards, the California Nursing Practice Act, Title 22, federal long-term-care requirements, and District policy.Ensure allegations of abuse, neglect, exploitation, mistreatment, injuries of unknown source, and misappropriation are immediately protected against, reported, investigated, documented, and addressed within required timeframes.Ensure immediate resident protection, separation from alleged perpetrators when indicated, prompt notification to required authorities, preservation of records, completion of investigations, and follow-up reporting within applicable regulatory timelines; coordinate with the Administrator and appropriate District functions.Ensure accurate clinical records support care, regulatory compliance, quality measurement, and lawful billing and reimbursement.Infection Prevention and Antibiotic StewardshipPartner with the Infection Preventionist, Medical Director, consultant pharmacist, laboratory, and interdisciplinary team to implement the infection prevention and control program and antibiotic stewardship program.Monitor surveillance data, outbreaks, immunization practices, transmission-based precautions, hand hygiene, environmental practices, employee-health coordination, antibiotic use, resistance patterns, and required reporting.Coordinate with the designated Infection Preventionist on surveillance definitions, isolation/precautions, communicable-disease reporting, outbreak response, and antibiotic stewardship indicators, with documented corrective action when performance falls below expectations.Ensure clinical Teammates and practitioners receive required infection-prevention and antibiotic-stewardship education and follow current policies and evidence-based practices.Interdisciplinary Leadership and Resident ExperienceLead or participate in interdisciplinary care conferences, utilization review, admission review, discharge planning, pharmacy review, nutrition, rehabilitation, activities, social services, ethics, and other resident-care processes.Communicate effectively with residents, representatives, families, practitioners, the Medical Director, consultants, leaders, and Teammates; respond promptly and respectfully to questions, complaints, and changes in condition.Conduct regular nursing staff meetings and communicate regulatory changes, clinical expectations, quality results, equipment changes, and lessons learned.Promote a respectful, inclusive, psychologically safe workplace and address incivility, retaliation, inconsistent accountability, and barriers to speaking up.Administration and Fiscal StewardshipDevelop and manage the nursing budget, staffing plan, productivity, overtime, supplies, equipment, and contracted services while preserving resident safety and mandatory staffing.Maintain accurate schedules, timekeeping approvals, personnel documentation, competency records, quality reports, and regulatory records within required timeframes.Evaluate and secure supplies, equipment, technology, and service arrangements necessary for safe care; ensure required maintenance, inspection, and staff training.Provide timely reports to the Chief Nursing Officer / Chief Administrative Officer, Chief Executive Officer, committees, and governing body as requested.Participate in emergency preparedness and incident command activities and provide nursing leadership coverage outside regular hours as operationally required.Ensure DP SNF nursing participation in the facility emergency preparedness plan, including evacuation and shelter-in-place, resident tracking, medication and equipment continuity, staffing contingencies, communications, and exercise-related corrective actions.Perform other duties consistent with the position, licensure, competence, District policy, applicable collective bargaining agreements, and law.Role ExpectationsIn performing the responsibilities of this position, the Teammate shall:Demonstrate the District’s Mission, Vision, and PEAKS values.Promote a respectful, inclusive, and psychologically safe workplace.Maintain patient, resident, employee, and organizational confidentiality.Report safety, quality, compliance, and ethical concerns promptly.Participate in performance improvement, education, emergency preparedness, and required training.Work collaboratively across departments and support the District’s commitment to safe, high-quality care.Perform assigned responsibilities in accordance with District policies, applicable collective bargaining agreements, professional standards, and federal and California laws and regulations.Minimum QualificationsEducation and ExperienceGraduate of an accredited registered nursing program.At least one year of nursing-supervision experience within the preceding five years, as required by California Code of Regulations, title 22, section 72327.At least two years of clinical experience in skilled nursing, long-term care, geriatrics, rehabilitation, or a closely related setting.Preferred: Bachelor’s degree in nursing or a related field; progressively responsible nursing-leadership experience; and demonstrated success with QAPI, staffing, infection prevention, survey readiness, and plans of correction in a skilled nursing facility.Licensure and CertificationCurrent, active, and unrestricted license as a Registered Nurse issued by the California Board of Registered Nursing.Current Basic Life Support certification from an approved provider.Additional certifications required by District policy or assigned clinical responsibilities.Knowledge Skills and AbilitiesKnowledge of gerontological and rehabilitative nursing, the nursing process, person-centered care, dementia care, resident rights, abuse prevention, infection prevention, medication management, and emergency response.Working knowledge of 42 CFR Part 483, CMS survey guidance, California Title 22 skilled nursing requirements, the California Nursing Practice Act, HIPAA and CMIA, and applicable employment and labor requirements.Ability to plan staffing from resident needs and facility assessment data; interpret quality indicators; conduct fair reviews; develop policies; implement corrective action; and demonstrate sustained compliance.Ability to lead calmly in a rural healthcare environment, make sound decisions, resolve conflict, manage competing priorities, and communicate effectively with residents, families, Teammates, practitioners, regulators, and leadership.Proficiency with electronic health records, MDS and care-planning workflows, staffing and scheduling systems, incident reporting, quality dashboards, and office applications.Leadership RelationshipsDirect Reports: Skilled nursing leaders and nursing Teammates assigned in the approved organizational structure.Key Relationships: Chief Nursing Officer; Chief Executive Officer; Medical Director; attending practitioners; Director of Staff Development; Infection Preventionist; MDS and interdisciplinary care team; Human Resources; Quality; Employee Health; Pharmacy; Rehabilitation; Dietary; Social Services; Activities; residents; resident representatives and families; regulators; vendors; and registry partners.Regulatory Authority: Written administrative authority, responsibility, and accountability for nursing services within the Distinct Part Skilled Nursing Facility. The Director serves only this facility in the regulatory Director of Nursing Services capacity at any one time.Physical Mental and Environmental RequirementsThese requirements describe the general demands of the position. The District will consider reasonable accommodation for qualified individuals with disabilities through an individualized, interactive process.Frequently communicates, observes, reads, writes, uses computers and clinical systems, and exercises sustained judgment and attention to detail.Frequently sits, stands, and walks throughout resident-care and administrative areas; occasionally bends, reaches, climbs stairs, and moves between District locations.May assist with resident movement or emergency response within training and safe-patient-handling procedures. Specific lifting and mobility requirements shall be assessed through the District’s approved physical-demands process.May be exposed to infectious disease, blood or body fluids, hazardous materials, combative behavior, noise, and urgent or emotionally stressful conditions; required personal protective equipment and safety practices must be used.Must be able to respond to operational needs outside regular business hours and participate in nursing leadership or emergency coverage as assigned.
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