Staffing Shortages Lead to Delayed Care and Supervision
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of residents, as evidenced by the staffing shortages observed during the recertification and abbreviated surveys. Specifically, the facility did not meet the minimum staffing levels outlined in their Minimum Staffing Standard Matrix on sixty-nine out of ninety-six shifts, and on nine out of thirty-two night shifts, the staffing fell below the general staffing plan documented in the Facility Assessment. Interviews with staff revealed that these shortages led to delays in resident care and meals, with some staff members being mandated to work additional shifts, which affected their ability to perform their duties effectively. Observations on the dementia unit highlighted the impact of staffing shortages, with unsupervised residents appearing confused and unable to find seats in the day room. Staff interviews confirmed that the dementia unit often operated with fewer certified nurse aides than required, which compromised the supervision and care of residents. Additionally, the lunch service on the 3rd floor was delayed, with some residents receiving their meals significantly later than others, further indicating the strain on staff resources. The report includes multiple staff testimonies describing the negative effects of working with insufficient staff, such as residents not receiving timely assistance with toileting and transfers, and meals being delayed. These deficiencies in staffing and care delivery were corroborated by the facility's own staffing records and staff interviews, which consistently pointed to a pattern of inadequate staffing levels that failed to meet the facility's documented standards.
Plan Of Correction
Plan of Correction: Approved March 21, 2025 F 725 Sufficient Nursing Staff I. The Following Actions were accomplished to ensure minimum staffing levels for certified nurse aides are met on all shifts: A review of the facility-wide assessment was conducted on 3/17/25 based on the revised Medicaid CMI to re-evaluate the allocation of resources needed to care for the residents. The facility-wide assessment will provide information regarding direct care staff needs and capabilities to provide services to the residents. II. The following corrective actions will be implemented to identify other residents who may be affected by the same practice: All residents have the potential to be affected by the deficient practices. The facility-wide assessment conducted will re-evaluate the allocation of resources and staffing on all shifts. Corrective action will include following the minimum determined staffing levels for certified nurse aides on all shifts. III. The following systemic changes will be implemented to ensure minimum staffing levels for certified nurse aides are met on all shifts: The Administrator and Director of Nursing will provide education to the Staffing Coordinators on the importance of meeting minimum staffing requirements for all shifts. The Facility Assessment will be conducted on a routine basis by the Administrator and the Director of Nursing to review the staffing levels based on current Case Mix Index information and ADL and care needs of the residents. Any changes to the staffing levels in all shifts based on the facility assessment will be communicated to the staffing coordinator to ensure that staffing levels are maintained. When staffing levels are not at the designated levels after all resources available to the staffing coordinator will notify the Administrator and the Director of Nursing to determine additional actions needed to meet the needs of the residents’ levels determined by the facility assessment. The Administrator, along with the Director of Nursing, continuously works on hiring more C.N.A. staff for all shifts. The facility staffing levels improved over the last three months by successfully hiring more staff for all shifts. These new staff members assisted our residents needs by picking up shifts each week. Agency staff are also utilized to meet the needs if all employed staff solutions are exhausted. The facility has a plan to meet staffing requirements through an in-house recruiter who was recently hired and has helped tremendously with staff recruitment. Also, the facility has offered referral bonuses, sign-on bonuses and retention bonuses. An in-house childcare center will be opening soon and will be offered to all staff to help with recruitment and retention. IV. The facility’s corrective action will be monitored to ensure the deficient practice does not recur by utilizing the following Quality Assurance practices: The daily staffing is reviewed by the facilities Staffing Coordinator, Director of Nursing and Administrator to assure that the staffing levels meet the residents’ needs. These levels are reported weekly for 3 months. A quantitative summary of findings and corrective actions will be reported monthly to the Quality Assurance Performance Improvement Committee by the Director of Nursing. Responsible Person: The Director of Nursing is the person responsible to ensure all of the above actions have been completed.