Weekend Staffing Shortages Impact Resident Care
Penalty
Summary
The facility was found to have insufficient nursing staff to meet the needs of residents, particularly on weekends, as documented during a Recertification Survey and Complaint Survey. The facility's policy on staffing levels, revised in February 2024, aimed to ensure adequate and competent staffing based on the Facility Assessment. However, the Payroll Based Journal Staffing Data Report for the fourth 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 required per shift, but actual staffing schedules revealed consistent shortages, particularly on weekends. Interviews with residents and staff corroborated the findings of understaffing. Several residents reported delays in receiving care, such as incontinence care, assistance with dressing, and meal delivery, due to the lack of sufficient staff. One resident mentioned that the issue was more pronounced on weekends, while another resident's representative noted that understaffing affected timely feeding during mealtimes. Certified Nursing Assistants also reported that being short-staffed led to delays in providing morning care and other essential services. The facility's Director of Nursing and Administrator acknowledged the staffing issues, attributing them to increased callouts during the summer months and the inability to replace absent staff. Despite these acknowledgments, both denied receiving complaints from residents or staff regarding staffing levels. The facility's staffing coordinator was uncertain about the extent of understaffing and noted that the facility did not offer incentives for staff to cover short-staffed shifts.
Plan Of Correction
Plan of Correction: Approved March 5, 2025 **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** This provider submits the following plan of correction in good faith and to comply with Federal Law. This plan is not an admission of wrongdoing, nor does it reflect agreement with the facts and conclusions stated in the statement of deficiencies. 1) Immediate actions taken for those residents identified: Bensonhurst Center will provide sufficient nursing staff with the appropriate competencies and skill sets to provide nursing and related services to assure resident safety and attain and maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and [DIAGNOSES REDACTED]. No negative outcomes were identified for the residents noted in this citation (Resident #120, Resident #3, Resident #36, and Resident #43) as the result of this alleged deficient. All four residents continue to remain in the facility for long term care. None of them had any falls, weight loss or otherwise negative decline due to weekend staffing. 2) How the facility identified other residents: A combination of 20 Family Members/Residents were asked a 3-question survey week of (MONTH) 23rd. 14 Residents and 6 Family Members were surveyed: 1. Have you waited longer for care on weekends? 2. Have you noticed fewer staff on weekends (aside from management that don’t work weekends)? 3. Do you wish to file any grievance regarding care over the weekends? All responded no to these questions. Copies of these surveys are kept for verification. A review of weekend staffing over the last 2 weeks shows that each day fell within the parameters of the updated Facility Assessment. A Resident Council Meeting was held on 3/4/2025 to discuss the weekend staffing. 3) Measures put into place/System changes: 1. Facility Assessment was reviewed, revised, and updated to reflect current resident population acuities and staffing pattern needs on a 7-day basis. 2. A review of the master schedule was conducted and the facility identified all FT/PT openings. A union required posting for open shifts was posted at the facility time clock and was advertised on employment platforms. HR is actively recruiting for these open positions. 3. Two Nursing orientations were conducted since Survey exit. 4. Staffing Coordinator was educated on the appropriate staffing ranges that are required on a daily basis to ensure compliance with Facility Assessment. 5. On a weekly basis, the DON/Admin will review the weekend schedule between Thursday and Friday and devise a plan to ensure compliance with weekend staffing needs. This plan may include offering OT, mandating staff, requiring Management staff to work over the weekend or other potential interventions. 6. All nursing supervisors were educated to the above plan which they are empowered to implement (offering OT, mandating and other interventions). Furthermore, they were educated to notify DON/Admin should staffing fall below the requirements as identified in the Facility Assessment. 4) How the corrective actions will be monitored: An audit tool has been created, which will be completed weekly x8 weeks and then monthly x 6 months. This tool will be a retrospective review of weekend staffing to ensure it meets facility staffing needs as indicated in the facility assessment. The results of this audit will be presented at QAPI and will be the responsibility of the DON/Administrator. The DON/Administrator is responsible for this plan of correction.