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P5640

Facility Staffing Deficiency

Lititz, Pennsylvania Survey Completed on 01-15-2025

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 Per Patient Day (PPD) of 3.2 hours of direct resident care for each resident on two specific days within a ten-day period. A review of the facility's staffing data from December 31, 2024, through January 9, 2025, revealed that on December 31, 2024, the facility provided only 2.83 hours of care, and on January 1, 2025, it provided 2.93 hours of care. This deficiency was confirmed with the Nursing Home Administrator during a telephone interview on January 15, 2025.

Plan Of Correction

1. Facility can not retroactively correct. 2. All residents had the potential to be affected; however, there were no adverse resident outcomes as a result of the deficient practice. 3. Licensed staff have been re-educated on staffing requirements by the DON or designee. An ongoing systemic change put in place is the review of staffing in daily meeting. 4. The Administrator/Director of Nursing/and/or designee will audit the schedule weekly for four weeks and then monthly for two months to ensure appropriate coverage is in place.

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