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P5520

Nurse Aide Staffing Shortage on Day Shift

Meadville, Pennsylvania Survey Completed on 01-14-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to meet the required nurse aide (NA) staffing ratios during the day shift on January 12, 2025. Specifically, the regulation mandates a minimum of one NA per 10 residents during the day shift. On the day in question, the facility had a census of 114 residents, necessitating 11.40 NAs to meet the required ratio. However, only 9.38 NAs were available, resulting in a staffing shortage. This deficiency was confirmed during a telephone interview with the Nursing Home Administrator on January 14, 2025, who acknowledged that the NA ratios were not met for the specified day and shift.

Plan Of Correction

Preparation and submission of this plan of correction is required by state and federal law. This plan of correction does not constitute an admission for purposes of general liability, professional malpractice or any other court proceeding. In an effort to maintain compliance with the regulation, the facility should utilize the following process: 1. In an attempt to achieve appropriate staffing ratios, the facility has created a daily assignment grid for the Scheduler to complete daily that designates the required amount of Certified Nurse Aides per shift that are required to meet the regulatory requirements. The assignment grids will be reviewed during Labor Meetings to be held no less than weekly. This review will be the responsibility of the Director of Nursing or designee. 2. When a call-off is received, the Supervisor will make every effort to replace hours fully. In the event that the Supervisor is unable to fully cover the hours of a staff call-off and the loss of staff might impact the facility's compliance with the regulatory requirement, the RN Supervisor will notify the Director of Nursing and Assistant Director of Nursing so that all administrative clinical staff can be notified of the need so they can assist with coverage. 3. The facility will continue with recruitment efforts and will continue to enforce the attendance policy. 4. The facility shall complete a monitor of staffing ratios weekly utilizing the DOH staffing calculation tool for 1 month, then monthly for 2 months, then quarterly until such time it is determined by the Quality Assurance Committee that the facility is maintaining compliance. This shall be the responsibility of the Director of Nursing or designee.

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