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P5640

Failure to Meet Minimum Nursing Care Hours

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 meet the regulatory requirement of providing a minimum of 3.2 hours of direct resident care per patient day (PPD) for 18 out of the 21 days reviewed. This deficiency was identified through a review of nursing staffing hours and confirmed by an interview with the Administrator. Specific dates where the facility did not meet the required hours include several days in September, October, and December 2024, with PPD ranging from 2.47 to 3.19 hours, all below the mandated 3.2 hours. The deficiency was confirmed by the Administrator on December 30, 2024.

Plan Of Correction

Unable to retroactively correct. The facility will provide staffing to meet the ratio based on July 1, 2024 regulation change of 3.2 hours PPD. 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 review PPD to ensure that 3.2 is met. These audits will be discussed at the monthly QAPI meeting for further review and recommendation.

See complete original report
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