P5530

Deficiency in LPN Staffing Levels

Philadelphia, Pennsylvania Survey Completed on 12-23-2024

Penalty

No penalty information released

Summary

The facility failed to meet the required minimum staffing levels for Licensed Practical Nurses (LPNs) on both the day and evening shifts for one of the seven days reviewed during the week of December 15, 2024. Specifically, on December 21, 2024, the day shift had only 25 LPN hours scheduled, while the resident census of 155 required 49.6 LPN hours. Similarly, the evening shift had 37.48 LPN hours scheduled, whereas the same resident census required 41.33 LPN hours. This deficiency was confirmed through an interview with the Nursing Home Administrator, Employee E1, on December 23, 2024.

Plan Of Correction

Plan of Correction for § 211.12(f.1)(4)
Nursing Services:

1. Review of LPN Staffing Ratios:
The facility reviewed the LPN staffing ratios for December 21, 2024. No grievances were filed or resident care was negatively affected on that date due to staffing ratios.

2. Expanded Review:
Additional dates were reviewed to ensure that LPN staffing ratios were met and to confirm that resident care levels were not adversely impacted.

3. Education on Staffing Ratios:
The scheduling coordinator will be educated on the LPN staffing ratio requirements:
- Day Shift: Minimum of 1 LPN per 25 residents.
- Evening Shift: Minimum of 1 LPN per 30 residents.
- Night Shift: Minimum of 1 LPN per 40 residents.

4. Monitoring and Audits:
The NHA or designee will conduct audits of LPN staffing ratios for all shifts. These audits will be conducted weekly for four weeks to ensure compliance.

5. Quality Assurance Reporting:
Audit results will be reviewed at the Quality Assurance and Performance Improvement (QAPI) committee for evaluation and further action as needed.