Failure to Meet Minimum Nursing Care Hours
Penalty
Summary
The facility failed to meet the regulatory requirement of providing a minimum of 3.2 hours of direct resident care per resident in a 24-hour period. This deficiency was identified during a review of nursing staffing documents for the period from August 1, 2024, to August 7, 2024, where it was found that on August 7, 2024, the facility provided only 3.16 hours of direct care per resident. The Nursing Home Administrator confirmed the accuracy of the staffing information and acknowledged the failure to meet the required care hours on the specified date.
Plan Of Correction
Facility Staffing Coordinator was reeducated on current nursing care hours provided according to current census and shifts. Facility will attempt to utilize facility staff and temporary staffing agencies as needed. Facility weekly Schedule will be made in accordance with current Pennsylvania DOH Staffing guidelines and facility census. Nursing Supervisors to be in-serviced on staffing guidelines by 1/8/2025. For the date indicated all residents in the facility received the care that they required, and the facility received no complaints from residents, their responsible person(s) or employees. Schedule and census will be monitored daily per shift by RN Nursing Supervisor for call offs and changes in census. Adjustments will be made as needed by Director of Nursing, RN Nursing Supervisor or Staffing Coordinator. Facility will utilize facility staff and or temporary Staffing Agencies to fill in shifts as needed to comply with current nursing care hours in a 24-hour period. Assistant Administrator or designee will monitor schedules at least weekly x 4 weeks and then every 2 weeks until deemed in compliance by facility QAPI Committee.