Staffing Deficiencies Lead to Unmet Resident Needs
Penalty
Summary
The facility failed to ensure sufficient nursing staff were available to meet the needs of residents, as observed during a recertification survey. On the Head Injury Rehabilitation Unit, 13 out of 15 residents remained in bed late into the morning due to insufficient staffing, with only one Certified Nursing Assistant (CNA) available to care for all residents, despite the requirement for two-person assistance. This CNA was unable to provide scheduled showers and had to perform tasks alone that required assistance, compromising resident care. In the Inn Unit, a resident did not receive scheduled showers on two occasions due to understaffing. The unit was consistently short-staffed, with only two CNAs available for 38 residents, many of whom required two-person assistance. This led to delays in care, including missed showers and late transfers back to bed, as CNAs struggled to manage high resident-to-staff ratios. The [NAME] Hall Unit also experienced staffing shortages, with only one CNA assigned to 46 residents during a night shift. This resulted in incomplete care for many residents, as the CNA could only attend to their assigned residents. The facility's staffing policy was not adhered to, and the lack of agency staff exacerbated the issue, leading to significant gaps in resident care and unmet needs.
Plan Of Correction
Plan of Correction: Approved January 21, 2025 I. The following actions were accomplished for the residents identified in the sample: Resident #38 The Nurse Manager for Resident #38 met with the resident to discuss his/her concerns. Resident #38 was provided with a shower. The Nurse Manager provided additional education to unit staff regarding their responsibility for following the resident’s plan of care, including his/her shower schedule. II. The following corrective actions will be implemented to identify other residents who may be affected by the same practice: All residents have the potential to be affected by the same practice. Between 11/29/24 and 12/10/2024 the Nurse Manager/designee for the Lawrence Hall Unit met with each resident and/or representative to discuss their preferences for related to their out of bed schedule. The Nurse Manager updated the care plan to reflect the resident’s preference for getting out of bed, updated the CNA’s assignment and reviewed the care plan revisions with the unit staff. A comprehensive review of ADL documentation from the last quarter will be conducted by the Nurse Managers/supervisors to identify any potential concerns related to provision of care, including adherence to shower schedules and out of bed preferences. Consideration will be given to redistribution of routine tasks to different shifts, if possible, to assist with staff efficiency and completion of required duties. Effective 12/10/2024, the Unit Managers for all units, including the Muhlenberg unit, were directed by the Chief Nursing Officer to conduct additional observational rounds to ensure each resident’s plan of care is being carried out consistently as it relates to showers, out of bed and other needs. Any concerns identified will be immediately addressed, such as re-educating staff about the plan of care and ensuring the resident’s need is met, such as being assisted out of bed at that time or a shower provided. The Nurse Manager/designee will include assessing completion of shower associated documentation as part of the observation rounds. The Unit Managers will review the list of resident shower schedules, out of bed preferences/schedules and other scheduled ADL assistance with responsible staff to ensure the plan of care is consistently carried out. CNAs who cannot complete all assigned duties during a shift will report this concern to the Unit Manager/Nurse Supervisor for timely follow-up. The Social Worker for each unit will meet with a random sample of five different interview-able residents monthly to conduct an interview regarding satisfaction and their perception of care and staffing, including as it relates to receiving showers and being assisted out of bed in accordance with their preferences. The results of these structured interviews will be provided to the Director of Social Work for reporting to the Administrator and Chief Nursing Officer. This information will be utilized as appropriate to inform staffing needs for all units and shifts. The Staff Educator/designee will provide additional education to all Nursing staff regarding their responsibility to ensure that the plan of care is followed for all residents, including adhering to shower schedules, assisting residents with getting out of bed, and other care directives. Licensed staff were re-educated regarding their responsibility to assist CNAs, as needed, including for residents who require two-person assistance. III. The following system changes will be implemented to assure continuing compliance with regulations: The Administrator and Chief Nursing Officer reviewed the facility’s staffing policy and procedure and Facility Assessment to determine if any revisions were necessary to staffing levels to meet resident care needs. The Chief Nursing Officer/designee will educate the Staffing Coordinator, Assistant Director of Nursing and Nursing Supervisors regarding the need to ensure that actual unit-based staffing is based on the staffing levels included in the Facility Assessment. The Chief Nursing Officer/designee will continue to direct responsible staff to immediately attempt to fill any staffing need due to call-ins and document attempts to obtain additional staff, whether it is through advising existing staff of additional shift opportunities or contacting agencies to supplement facility staffing needs. The Administrator and the Chief Nursing Officer will convene routine staffing assessment meetings to review actual staffing levels, call outs, double shifts, retention and use of agency staff and to determine if any staffing level changes are necessary based on the current census. The facility will continue to advertise and actively promote all open roles at the facility through online job postings, on-site job fairs and explore additional opportunities for recruitment and retention, including contacting local nursing schools to identify additional prospective staff. The facility will create an incentivize sign on bonus program for new employees to help with recruitment/retention. The Administrator and Chief Nursing Officer will continue to employ all available tactics to attract and retain staff, including exploring additional staffing agencies to contract with. Attempts to hire additional agency staff are continuously underway. The Administrator and Chief Nursing Officer will continue to explore opportunities to increase staff retention, which is an identified concern. The facility will explore an incentivize Mentorship program by pairing experienced staff with new hires to foster guidance, support and connection. The facility is exploring additional options for weekend shift incentives to increase retention. IV. The facility’s compliance will be monitored utilizing the following quality assurance system: The facility will develop an audit tool to monitor the facility’s compliance with meeting sufficient staffing requirements, as determined by the Facility Assessment’s staffing plan. The Chief Nursing Officer/designee will audit the facility’s actual staffing daily against the facility’s master staffing plan and report to the QAPI Committee on an ongoing, monthly basis regarding staffing status changes. The facility’s recruitment and retention efforts will be reviewed quarterly during QAPI Committee meetings on an ongoing basis. Completion Date: 01/31/2025 Responsibility: Chief Nursing Officer