Inadequate Staffing Leads to Delayed Care and Resident Concerns
Penalty
Summary
The facility failed to provide sufficient nursing staff to ensure timely response to call lights and adequate assistance with activities of daily living (ADL) care, affecting all 83 residents. During a resident meeting, several residents reported experiencing extended wait times for call light responses, particularly during the evening and overnight shifts. One resident expressed anxiety due to waiting 2 to 3 hours for call light responses, which delayed incontinence care and access to PRN medication. Another resident was unable to attend a meeting because a CNA did not assist him in getting up, despite his request to participate in activities. The Resident Council Meeting minutes from December 2024 to March 2025 consistently documented concerns about delayed call light responses, insufficient care on weekends, and delayed medication administration. The facility's staffing records revealed a significant discrepancy between the required and actual number of CNAs on duty. The facility assessment indicated a need for 30 CNAs in a 24-hour period, but daily assignment sheets showed only 20 CNAs were working. Units with residents requiring two staff assists were often staffed with only one CNA, leading to inadequate care. The staffing coordinator acknowledged that CNAs from other units or nurses could assist, but this could leave units understaffed. The administrator admitted that an evaluation of resident care needs in relation to CNA staffing was not conducted in response to the concerns raised in Resident Council Meetings.