Staffing Deficiency in Nurse Aide Ratios
Penalty
Summary
The facility failed to meet the required nurse aide to resident ratios on 18 out of 48 shifts reviewed. The regulation, effective July 1, 2024, mandates a minimum of 1 nurse aide per 10 residents during the day, 1 per 11 residents in the evening, and 1 per 15 residents overnight. However, the facility's staffing records revealed multiple instances where the number of nurse aides fell short of these requirements. For example, on December 17, 2024, the night shift had 5.5 nurse aides instead of the required 6.73 for a census of 101 residents. Similar deficiencies were noted on various dates, including December 22, 24, 25, 26, 27, 28, 29, 30, 31, 2024, and January 1, 2025, across different shifts. The Nursing Home Administrator confirmed during an interview on January 3, 2025, that the facility did not meet the required nurse aide to resident ratios on the specified dates. Additionally, there were no higher-level staff available to compensate for the staffing deficiencies. This lack of adequate staffing was consistent across several shifts, indicating a systemic issue in maintaining the mandated staffing levels.
Plan Of Correction
The facility cannot retroactively correct the Nurse Aide Staff to resident ratios on past shifts identified. The facility cannot retroactively correct the Nurse Aide Staff to resident ratios on previous shifts. The NHA/Designee educated the Nursing Staff Scheduler and Director of Nursing on minimum nurse aide to resident ratios on all shifts, ensuring continued proactive planning and follow up to address issues identified. Daily staffing meetings will be held with the NHA, Staff Scheduler, DON, and other team members as necessary to review per patient ratios 5 days per week to review projected staffing, reconcile prior days staffing, and follow up as needed for continued improvement and comprehensive team approach. The facility utilizes contracted nursing staff, incentives, and flexible schedules etc. for current staff, focuses on recruitment of direct hire staff for continuity of care as well as employee engagement, feedback through town hall meetings, and individualized support to decrease absences. A call-in list is used to attempt to fill unexpected absences. Resident occupancy is reviewed and revised as needed with IDT during staffing meetings. The NHA/Designee will quality monitor Nurse Aide to resident ratios 5 days per week for 4 weeks, then one per week for 3 weeks, then monthly for 2 months to ensure minimum Nurse Aide to resident ratios are met. The NHA/Designee will quality monitor daily staffing meetings 5 days per week for 4 weeks, weekly for 3 weeks, then monthly for 2 months to ensure staffing meetings are occurring with required attendees.