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P5520

Staffing Deficiencies in Nursing Services

Williamsport, Pennsylvania Survey Completed on 12-30-2024

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 comply with the Pennsylvania Long Term Care Licensure Regulations regarding nursing services staffing levels. Specifically, the facility did not maintain the required minimum number of nurse aides per resident during various shifts over a 21-day review period. During the day shift, the facility was understaffed on eight days, with the number of nurse aides falling short of the required ratio of one nurse aide per 10 residents. For example, on December 25, 2024, with a census of 118 residents, only 6 nurse aides were available, whereas 11.80 were required. The evening and overnight shifts also experienced staffing shortages. The evening shift was understaffed on 15 days, with the number of nurse aides not meeting the required ratio of one nurse aide per 11 residents. On December 25, 2024, with a census of 118 residents, only 7.20 nurse aides were available, while 10.73 were required. Similarly, the overnight shift was understaffed on 12 days, failing to meet the required ratio of one nurse aide per 15 residents. On December 25, 2024, with a census of 118 residents, only 6.40 nurse aides were available, whereas 7.87 were required. These findings were confirmed by the facility's administrator during an interview.

Plan Of Correction

Unable to retroactively correct. The facility will provide staffing to meet the ratio based on July 1, 2024 regulation change of 1 nurse aide per 10 residents on day shift, 1 nurse aide per 11 residents on evening shift, and 1 nurse aide per 15 residents on night shift. DON and RN Supervisors will be re-educated on staffing ratio minimums and the appropriate response to unplanned variations in ratio. NHA/designee during weekday daily review of nursing schedules will be discussed at the monthly QAI meeting for further review and recommendation.

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