Insufficient Nursing Staff Leads to Delayed Resident Care
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of its residents, as evidenced by interviews and observations. Resident R51, who requires assistance with mobility and transfers, reported waiting for an hour on the toilet for help and experiencing soiling due to delayed assistance. Additionally, during a Resident Council meeting, six alert and oriented residents expressed concerns about long wait times for call bell responses, particularly during the 3-11 shift and weekends. These residents have adapted by doing what they can for themselves, as they do not expect timely assistance. Further interviews revealed that Resident R12 had to wait until late morning for a shower and has not been walked by staff for months. Resident R34 reported not receiving a shower and sleeping in a recliner to manage bathroom needs independently. Resident R80, who has a physician's order for walking three times a week, has not been walked since January due to restorative aides being reassigned to work as nurse aides. Observations confirmed that restorative staff are often pulled to cover nursing shortages, limiting their ability to perform restorative duties effectively.
Plan Of Correction
1. Resident R80's restorative nursing care orders for ambulation were resumed. An announcement will be made at resident council to state that we were made aware that there are concerns with call bell response time, showers being completed that are related to staffing concerns. This plan of correction will be shared with the residents at resident council. Resident R12's concern regarding lack of assistance with walker use has been reviewed. The assigned staff have been re-educated on the resident's mobility needs, and restorative nursing aides are now ensuring assistance is provided per the care plan. Follow-up checks will be conducted weekly for four weeks to ensure continued compliance. Residents R12 and R34, who reported missed showers, will be interviewed, and their care plans have been reviewed to prevent recurrence. Assigned CNAs have been counseled on adherence to shower schedules, and their performance is being monitored. 2. An audit will be completed by the Director of Nursing or her designee and the Registered Nurse Assessment Coordinator or her designee on all residents with restorative nursing orders to see if they are still appropriate and if their orders are being fulfilled. An initial audit will be conducted by the Director of Nursing or her designee to see if showers are being completed. This audit will be conducted on 35% of the resident census. A revision of the current shower schedule will be revised if the audits result in ongoing issues with shower completion. 3. The restorative nursing program at Pinecrest Manor will be restructured where the current restorative nursing aides and coordinator will be training other staff members to be certified in restorative nursing to ensure that orders are fulfilled. All nursing employees will be re-educated by the Director of Nursing, Administrator or their designees on shower schedules, the importance of toileting, rounding and ambulation, shower schedules and documentation requirements, and call bell expectations and timeliness. 4. Audits will be completed by the Restorative Coordinator or her designee on all residents with restorative nursing orders to ensure that orders are completed and that their physical and mental needs are met. These audits will be completed by the Restorative Coordinator or designee weekly for 4 weeks and monthly thereafter. These results will be reported at the Quarterly Quality Assurance Meeting. Rounds will be completed by the Director of Nursing, Administrator or her designee to ensure that call bells are being answered in a timely manner. During these rounds, a resident will be interviewed to discuss any concerns. These rounds will occur every other week where 5 residents will be interviewed to make sure their needs are met. Audits on showers being completed will be completed by the Director of Nursing or her designee on 15 residents per week for 4 weeks and then monthly thereafter. These results will be reported at the Quarterly Quality Assurance Committee Meeting. The Director of Nursing and Administrator will oversee implementation and review findings to determine if additional corrective actions are necessary. 5. Corrective action date will be April 10, 2025.