Failure to Provide Sufficient Nursing Staff and Timely ADL Assistance
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents, as evidenced by multiple resident interviews, staff interviews, and record reviews. Several residents reported that their call lights were not answered in a timely manner, and that they were left soiled in urine and stool for extended periods. One resident stated that call lights were not answered 30% of the time, and that there was no coverage when CNAs went to lunch. Another resident reported being left wet and soiled for an entire day shift, and that staff did not respond to complaints. Additional residents described being left in urine and stool multiple times, particularly on weekends, and feeling that administration did not care. Residents involved had significant medical conditions, including morbid obesity, acute respiratory failure, heart failure, diabetes, amputations, and mobility limitations, and were dependent on staff for activities of daily living (ADLs) such as toileting, bathing, and dressing. Record reviews confirmed that the facility did not meet the required minimum Actual Total Direct Care Service Hours (DCSH) of 3.5 and CNA DCSH of 2.4 hours for multiple days in March. On several dates, the number of residents assigned to each CNA exceeded the facility's own guidelines, with some CNAs responsible for up to 16 residents per shift. Staff interviews corroborated these findings, with CNAs reporting high resident assignments, feeling rushed, and being short-staffed on both weekdays and weekends. The Director of Staff Development (DSD) and Director of Nursing (DON) acknowledged that staffing levels and direct care hours were not met, and that this affected the quality of resident care. Facility policies and job descriptions reviewed indicated that staff were expected to respond to call lights promptly and ensure that residents' needs were met in accordance with their care plans. However, the documented staffing shortages, high resident-to-CNA ratios, and failure to meet direct care hour requirements resulted in residents not receiving timely assistance with ADLs, leading to frustration, anger, and negative impacts on their quality of care.