Staffing Deficiency in LPN Coverage
Penalty
Summary
The facility failed to meet the required staffing levels for nursing assistants and licensed practical nurses (LPNs) on specific shifts. On 1/17/25, during the evening shift, the facility did not provide the minimum required number of LPNs, with only 17.26 actual hours of LPN coverage against the required 21.70 hours for a census of 84 residents. This deficiency was confirmed by the Nursing Home Administrator during an interview on 1/24/25. Additionally, the facility did not provide the necessary nursing assistants on certain shifts, as confirmed by the Nursing Home Administrator, although specific details of these shifts were not provided in the report.
Plan Of Correction
There were no effects to the residents of our facility as a result of decreased licensed nurse staffing ratios on 1/17/25. The Director of Nursing, Human Resources, and the Scheduler will be re-educated on the New July 1 licensed nurse to resident ratios by the Nursing Home Administrator or Designee. Staffing meetings will be held 3 days a week to review the licensed nursing staff ratios for the previous and current day, as well as the upcoming week to ensure appropriate staffing levels. If projected staffing levels are below the state mandated ratios, then the facility will reach out to current staff and to the staffing agencies to enlist staff to meet the minimum requirement. The facility will continue to recruit nursing staff through all platforms as well as utilize bonus structures and outside agencies. Audits of licensed nursing staff will be completed weekly x4 by the NHA/Designee to ensure licensed staff ratios meet the state minimums. Results of the audits will be reported to our QAPI committee monthly for review and recommendations.