Director of Health Services

The Director of Health Services leads the clinical services of the community to ensure residents receive safe, personalized, and compassionate care. The Director of Health Services oversees assessments, care planning, medication systems, infection control, documentation, clinical oversight of staff, and regulatory compliance. The Director of Nursing participates in hiring, onboarding, coaching, and recommendations for disciplinary action or termination related to clinical performance or safety concerns.

• Initiates contact to schedule required assessments within one business day of receiving necessary information or notification 100% of the time
• Completes 100% of required resident assessments within state-regulated time frames.
• Completes 100% of required resident assessments within state-regulated time frames.
• Completes 100% of individualized care plans within state-regulated time frames.
• Updates care plans according to required regulatory timelines following significant changes for 100% of applicable residents.
• Achieves at least 95% accuracy on quarterly care plan audits.
• Ensures 100% of residents are clinically cleared and care-planned per regulation prior to move-in.

• Ensures 100% real-time documentation of medication administration in the EMAR system
• Maintains a medication error rate below 1% monthly with documented corrective actions.
• Ensures 100% compliance with medication storage, disposal, renewals, and physician orders.

• Completes documentation and follow-up for 100% of incident reports within established timelines.
• Completes investigations for 100% of required clinical incidents within 24 hours.
• Achieves 100% compliance with mandatory reporting timelines.
• Implements at least one targeted clinical risk intervention per quarter based on identified trends.

• Achieves 98% documentation accuracy based on monthly chart audits.
• Demonstrates zero repeat deficiencies and completes required corrective actions within required timelines.
• Ensures 100% adherence to clinical policies and state regulations.
• Actively participates in QAPI meetings, contributes to QAPI projects, and completes assigned QAPI action items within required timelines 100% of the time.
• Maintains current knowledge of applicable state regulations and integrates updates into practice 100% of the time.

• Maintains 100% compliance with infection control standards and required reporting.
• Ensures 100% of clinical and care staff complete required infection control training and competencies.

• Notifies physicians and families within 24 hours of incidents and significant changes for 100% of applicable residents.
• Completes 100% of clinical handoffs and return-to-community documentation within 24 hours.
• Provides proactive clinical updates for 100% of residents at least quarterly.

• Leads clinical staff meetings at least monthly and ensures updates, expectations, and follow-up items are communicated to all clinical and care staff.
• Communicate relevant leadership information to the care team within two business days.

• Completes competency checks and supervisory visits for 100% of new hires and annually for all clinical and care staff.
• Initiates and documents corrective action for 100% of clinical performance concerns within five business days and recommends termination when clinical safety or competency thresholds are not met.

• Achieves 100% completion of required onboarding, annual training, and professional development for self and clinical/care staff.
• Maintains RN licensure in good standing 100% of the time.

• Supports resident engagement by participating in scheduled events and activities as appropriate to role and licensure and collaborates with leadership to promote resident involvement and a positive community environment 100% of the time.
• Supports marketing-related efforts by meeting prospective residents, supporting tours when clinically relevant, or providing information about clinical services when requested, and contributes to positive resident and family satisfaction outcomes 100% of the time.

• Current, active Registered Nurse (RN) license in the state where the community is located, in good standing and free of…