LPN Staffing Deficiency
Penalty
Summary
The facility failed to maintain the required staffing ratios for Licensed Practical Nurses (LPNs) on three specific days. On October 20, 2024, the facility had a census of 88 residents, necessitating 28.16 hours of LPN care during the day shift. However, only 24.00 hours of LPN care were provided, with no additional higher-level staff available to compensate for this shortfall. Similarly, on November 16, 2024, the facility census was 102, requiring 32.64 hours of LPN care during the day shift, but only 32.00 hours were provided. Additionally, during the evening shift on the same day, 27.20 hours of LPN care were required, but only 24.00 hours were provided, again without any higher-level staff to make up the difference. On November 17, 2024, the facility census remained at 102, requiring 32.64 hours of LPN care during the day shift, yet only 32.00 hours were provided. The Nursing Home Administrator confirmed these deficiencies during a review of staffing calculations, nursing staff schedules, and staff punch reports on December 10, 2024. The lack of adequate LPN staffing on these dates indicates a failure to meet the regulatory requirements for nursing services, as no additional staff were available to address the shortfall.
Plan Of Correction
Admin and DON will conduct random audits of resident charts, during those days identified as having fallen below required ratios, to ensure no negative outcomes in care. Scheduler will be reeducated on required staffing ratios for LPN's. Scheduler will be educated for staffing ratios for CNA's as relates to tag 5520. The Admin will conduct a random audit weekly to ensure facility is compliant with staffing ratios. Audit will be for x3 weeks. And monthly audit x4 months. Results will be reported to QAPI.