Failure to Meet CNA Staffing Ratios
Penalty
Summary
The facility failed to maintain the required minimum direct care staff-to-shift ratios as mandated by the state of New Jersey for three of the fourteen day shifts reviewed. Specifically, on three separate days, the facility had only 10 Certified Nurse Aides (CNAs) for 89 to 90 residents during the day shift, whereas the state requirement was at least 11 CNAs. This deficiency was identified through a review of staffing records for the period from November 17, 2024, to November 30, 2024. During an interview, the staffing coordinator acknowledged awareness of the CNA staffing ratios and admitted that while the facility usually meets these ratios, covering call-outs can be challenging. The facility's staffing policy, reviewed on December 11, 2024, outlines that the staffing coordinator is responsible for filling vacancies, initially attempting to cover shifts with per diem staff and, if unsuccessful, reaching out to agencies. Despite these procedures, the facility was unable to meet the mandated staffing levels on the specified days.
Plan Of Correction
To ensure all residents have access to the care they need, Reformed Church Home has cross-trained our nursing staff to perform CNA duties during the day shift in emergencies. All residents have the potential to be affected by the staffing shortage. In addition to using our nurse managers to perform direct care, we have also contracted with additional staffing agencies to provide temporary CNAs in the event of shortages. Overtime is offered to existing staff since we are usually trying to fill vacancies due to illness. The facility has taken multiple steps to address the CNA concern. Efforts are made to stay ahead of the pay scale and to have Reformed Church Home at the top of the wage scale. Reformed Church Home is also offering an additional health family plan which is lower in cost than our traditional plans. The hope again is that we will be able to attract more CNAs with families due to our competitive rates and enhanced health coverage for families. We have also partnered with the CNA school, Above and Beyond in Colonia NJ to provide guidance and graduating CNAs job opportunities. We have also contracted with additional staffing agencies to provide temporary CNAs in the event of shortages. We have also petitioned 6 visas for CNAs from United Methodist Healthcare Recruitment out of Chicago. To ensure the deficient practice does not recur, the Director of Nursing and Staffing Coordinator will review daily/weekly staffing levels daily to ensure compliance with the required ratios. A quarterly report will be made at the QA committee.