Staffing Shortages on Weekends in LTC Facility
Penalty
Summary
The facility failed to ensure sufficient nursing staff were available to meet the needs of residents, particularly on weekends, as identified during a recertification survey. The facility's policy required adequate staffing to provide necessary care and services, but the Payroll Based Journal Staffing Data Report for the 4th quarter of 2024 indicated excessively low staffing levels on weekends. The facility's staffing plan outlined specific numbers of licensed nurses and certified nursing assistants (CNAs) required per shift, but actual staffing schedules revealed frequent shortages of both nurses and CNAs across various units on weekends. Interviews with residents and staff corroborated the staffing deficiencies. Several residents reported that the facility was short-staffed on weekends, leading to situations where CNAs were responsible for 14-15 residents each, which is above the facility's standard. This resulted in delays in care, such as residents not being changed on time. Staff members, including CNAs and a Registered Nurse Supervisor, confirmed the high workload and frequent call-outs on weekends, which necessitated reassigning staff to cover shortages. The Director of Nursing acknowledged the staffing issues, attributing them to high turnover rates and staff having other jobs or being in school. The facility's administrator was unaware of the staffing shortfalls over the summer, which were exacerbated by increased absences due to vacations and holidays. The report highlights the facility's failure to maintain adequate staffing levels, impacting the quality of care provided to residents. Interviews with residents and their families indicated dissatisfaction with the care received, particularly on weekends when staffing was insufficient.
Plan Of Correction
Plan of Correction: Approved March 5, 2025 I. Immediate Corrective Action 1. The monthly staffing patterns as of (MONTH) 2025 will be reviewed by the DNS, ADNS and the Staffing Coordinator to ensure that there is sufficient nursing staff provided to meet the needs of the residents on all shifts. 2. Facility will actively continue to enhance staffing by contacting more agencies, advertise for hiring more staff, pay overtime when needed, offer incentives to work extra shifts, increase orientation classes with sign-on bonuses and offer opportunities to join the union when appropriate. 3. Resident # 34 met with the DNS, ADNS and Social Worker who reinforced the facility’s commitment to staffing and the importance of their safety as well as maintaining their highest physical, mental and psychosocial well-being as determined by their assessments and person-centered plan of care. II. Identification of others 1. The facility is aware that they must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans. The facility must designate a licensed nurse to serve as a charge nurse on each tour of duty. 2. The DNS/ADNS/RNS will review all staffing patterns prior to the schedule being posted to ensure that sufficient nursing staff is consistently provided to meet the needs of residents on all shifts. 3. An audit tool was developed by the DNS to review staffing to ensure that there is sufficient nursing staff provided to meet the needs of the residents on all shifts. This audit will be done for one week from 3/16/2025 to 3/22/2025 by the DNS / designee. All issues identified will be immediately corrected. III. System changes 1. The Administrator and DNS reviewed and revised the policy on “Staffing.” 2. ADNS, Staffing Coordinator, Licensed Nurses and Certified Nursing Assistants will be re-educated by the staff educator / designee on the above policy with emphasis on ensuring resident safety and attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and person-centered care plans. 3. Lesson plan and attendance sheets will be kept on record for validation. IV. Quality Assurance 1. The DNS developed an audit tool to ensure that there is sufficient staffing every day on all three shifts. 2. Audits will be done by the ADNS / designee daily x 4 weeks, 3 days a week monthly for 3 months, 3 days a week quarterly thereafter. 3. Any issues identified will have immediate corrective action taken by the DNS & reported to the Administrator. 4. The outcome of this audit will be quantified & reported to the QA committee by the DNS. V. The Director of Nursing will be responsible to ensure correction of this deficiency by 4/7/2025.