Staffing Shortages Lead to Delayed Resident Care
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of residents, compromising their safety and well-being. From December 1 to December 5, 2024, the facility did not meet its minimum staffing levels for Certified Nursing Aides (CNAs) and Licensed Practical Nurses (LPNs) across multiple shifts and units. This staffing shortage was evidenced by delayed call light response times, resident grievances, and complaints about low staffing levels. Observations during this period showed significant delays in call light responses, with some residents waiting over 50 minutes for assistance. The facility's staffing plan, as per the assessment dated August 28, 2024, outlined specific numbers of full-time employees required per shift. However, records from December 1 to December 5, 2024, indicated consistent shortages in staffing across various wings and shifts. For instance, on December 1, 2024, the evening shift was missing several CNAs and LPNs across different wings, and similar shortages were noted on subsequent days. These deficiencies were further corroborated by resident grievances filed between February and September 2024, highlighting issues such as long wait times for assistance, inadequate toileting support, and poor care due to insufficient staffing. Interviews with residents and staff further illustrated the impact of these staffing shortages. Residents reported long wait times for assistance, sometimes exceeding an hour, particularly during meal times when staff were occupied with other residents. Staff interviews revealed that understaffing led to slower care delivery, as staff from other units, unfamiliar with the residents, had to cover shifts. The Assistant Director of Nursing acknowledged the challenges in meeting call light response expectations, citing the high number of residents requiring mechanical lifts and the lack of adequate space to accommodate them. These factors collectively contributed to the facility's failure to maintain adequate staffing levels, directly affecting the quality of care provided to residents.
Plan Of Correction
Plan of Correction: Approved January 16, 2025 1. In the absence of resident-specific corrections to be made, the Administrator and/or Director of Nursing will meet with the Resident Council to review this Plan of Correction and request feedback. 2. All Customer grievances related to call bell response times over the last 12 months will be reviewed for trend identification to determine if there are root cause issues or common time/shifts/units, etc. If identified, focused action plans will be implemented. 3(a). The following strategies focused on staff recruitment and retention will continue to be implemented and continually adjusted based on response to address overall staffing levels. a. Aggressive recruitment campaign, including sign on bonus, referral bonus, tuition reimbursement, etc., with addition on 1/1/25 of new social media contract service. NOTE - agency nursing, including travel nurse resources are extremely scarce in rural areas. Several contracts are in place but unable to provide actual supplemental staff. Staffing requests remain pending and unfilled. Facility will review, screen and onboard agency staff that contracted agency finds. Current staff will continue to be offered significant shift bonuses (Up to $25 per hour differentials) for hard to fill shifts. b. Continued implementation of Nurse Aide training program, including evening classes (grant funded). c. Continued mentorship programs for newly hired Certified Nursing Assistants and Licensed Practical Nurses. d. Continued tuition reimbursement program (currently sponsoring 3 Licensed Practical Nursing students’ full tuition plus stipend for living expenses while in school). e. Incentive programs for longevity, attendance and other positive promotion strategies. 3(b). The following strategies will focus specifically on call light response times: a. Educational awareness program to be implemented for all clinical and support staff emphasizing the importance of call light response promptness. b. Review and revision of morning care routines for residents identified as consistently requesting assistance at predictable times with care plan adjustments as determined appropriate. c. Incorporate all staff, including ancillary department employees, with the responsibility to respond to call bells to address those issues and request within their scope of abilities, and communicate to nursing specific needs that may exist. d. No specific policy changes are indicated as this portion of the Plan of Correction focuses on staff awareness and education, combined with objective assessment of care delivery routines. 3(c). The Facility Assessment will be reviewed and updated to more clearly assess and articulate: a. Optimal staffing levels vs. minimally appropriate levels based on acuity and related variables required for appropriate resident care. b. Appropriate staffing adjustments based on census (as current Assessment and basis for deficiency is based on 100% occupancy but facility is not operating at that level). c. Recognition of support staff, reassigned staff, and other resources routinely accessed but not evident on daily staffing sheets. 4. Overall staffing levels by unit will be summarized daily and compared to the Facility Assessment optimal and minimally appropriate levels. Summarized and reported to Quality Assurance & Performance Improvement Committee monthly for six months. Total number of new hires and terminations for Certified Nursing Assistants and Licensed Practical Nurses, and overall turnover rates to be summarized monthly and reported to Quality Assurance & Performance Improvement for six months. No fewer than 5 visual observation audits (call bell response time) on different units and/or different times of day will be conducted weekly to measure call light response time. Audits will occur weekly for 3 months, followed by 10 audits per month for three months. Audit results to be reviewed by Quality Assurance & Performance Improvement Committee, which may extend or increase frequency based on results. Responsible Party: Administrator