Failure to Meet Minimum Nursing Care Hours
Penalty
Summary
The facility failed to meet the state regulation requiring a minimum of 3.2 hours of direct resident care per resident in a 24-hour period. On December 7, 2024, the facility provided only 3.02 hours of direct care nursing per resident, which is below the mandated minimum. This deficiency was confirmed during an interview with the Nursing Home Administrator on January 3, 2025, who acknowledged the facility's failure to consistently provide the required nursing care hours.
Plan Of Correction
Step 1 Facility can't retroactively correct. Step 2 To identify other areas of concern, the facility reviewed 1 week's worth of schedules to review PPD's. Step 3 To monitor and maintain ongoing compliance, the NHA/Designee will educate staff responsible for the nursing schedule related to the required PPD's. Step 4 To monitor and maintain ongoing compliance, the NHA/designee will audit the nursing schedule related to the PPD ratios 5x's/week for 2 weeks and then weekly for 4 weeks, and monthly for 3 months. The results of the audits will be forwarded to the facility QAPI committee for further review and recommendations.