Failure to Meet Nurse Aide Staffing Requirements
Penalty
Summary
The facility failed to meet the required staffing levels for nurse aides (NAs) as per the regulation effective July 1, 2024. During the review of nursing time schedules from March 2 to March 8, 2025, it was found that the facility did not provide the minimum number of NAs per residents across all shifts. Specifically, on the day shift, the facility did not meet the requirement of one NA per ten residents on March 2, 4, 7, and 8. On the evening shift, the facility failed to provide one NA per eleven residents on all days from March 2 to March 8. Additionally, on the night shift, the facility did not meet the requirement of one NA per fifteen residents on March 2, 4, 5, 6, 7, and 8. This deficiency was observed for all seven days reviewed, indicating a consistent failure to comply with the staffing regulation.
Plan Of Correction
1,2) Nurse aide staffing ratios will be reviewed for the last 7 days to evaluate if nurse aide ratio is met. 3) Nursing admin and scheduler will be re-educated on new July 1 nurse aide staffing ratio and PPD requirements. 4) Weekly audit of nurse aid ratios will be conducted for 60 days by NHA/designee to assure nurse aid ratio is met. Tracking and trends to be submitted to QAPI committee for any further action needed.