Staffing Deficiency in Nurse Aide Ratios
Penalty
Summary
The facility failed to meet the required nurse aide to resident ratios on 23 out of 63 shifts reviewed. The regulation, effective July 1, 2024, mandates a minimum of 1 nurse aide per 10 residents during the day, 1 nurse aide per 11 residents during the evening, and 1 nurse aide per 15 residents overnight. However, the facility's staffing records revealed multiple instances where the number of nurse aides was insufficient according to the census. For example, on December 22, 2024, there were only 2.13 nurse aides on the night shift, whereas 2.40 were required for a census of 36. Similar deficiencies were noted on various dates across day, evening, and night shifts. The director of nursing confirmed during an interview that the facility did not meet the required nurse aide to resident ratios on the specified dates. Additionally, there were no higher-level staff available to compensate for the staffing deficiencies. This lack of adequate staffing was consistent across several shifts, indicating a systemic issue in maintaining the required staffing levels as per the regulation.
Plan Of Correction
1. The Facility is unable to retroactively provide a minimum CNA ratio for cited days. 2. A facility wide audit was completed to ensure ratios were met. Recruitment initiatives were increased, and wages remain competitive for the area. 3. The DON and recruitment were reeducated on ensuring that the nursing care ratios are provided, and that the facility is actively recruiting CNAs. The DON will review census and schedule daily to ensure adequate staffing. 4. The DON or designee will conduct an audit of the nursing care ratios to ensure it is provided weekly x4 weeks then monthly x 2 months. The results will be submitted to the QAPI committee for review and analysis of need on an ongoing basis.