Staffing Deficiency in Nurse Aide Coverage
Penalty
Summary
The facility failed to meet the required staffing levels for nurse aides during the day shift on two specific dates. On September 1, 2024, the facility had a census of 300 residents, necessitating 30 nurse aides, but only 26.90 nurse aides were available. Similarly, on February 1, 2025, with a census of 309 residents, 30.90 nurse aides were required, yet only 29.83 were present. In both instances, there were no additional higher-level staff available to compensate for the shortfall, leading to a deficiency in meeting the mandated staffing requirements.
Plan Of Correction
Facility is staffing to maintain the required staffing ratios related to C.N.A's on all shifts. Staffing will be reviewed by facility administrator/designee prior to each shift to ensure required ratios are met. Interim steps include nursing on-call is in place, bi-weekly orientation schedule for new hires, OT and bonuses are offered. Random audits of daily staffing will be reviewed by Administrator/designee weekly X4 weeks to ensure required staffing ratios are met. Findings will be reviewed at QAPI monthly X2.