Failure to Provide Required Assistance with Activities of Daily Living Due to Staffing Shortages
Penalty
Summary
A deficiency was identified when the facility failed to provide necessary assistance with activities of daily living (ADLs), such as bathing, dressing, and toileting, to 59 out of 67 sampled residents who were unable to perform these tasks independently. These residents, many of whom had complex medical conditions including respiratory failure and tracheostomy tubes, were documented as requiring substantial or total assistance with ADLs according to their Minimum Data Set (MDS) assessments and care plans. The care plans specifically indicated that staff should provide assistance with ADLs as needed. Interviews with staff revealed that Certified Nursing Assistants (CNAs) were frequently assigned to care for a high number of residents, sometimes up to 14 per CNA, especially during periods of short staffing or when scheduled staff called off. The facility's practice was to assign a dedicated shower nurse to provide showers, but this role was often unfilled or reassigned to cover floor assignments when staffing was insufficient. As a result, scheduled showers and bed baths were routinely missed, and documentation (shower sheets) confirming that showers were provided was often absent. Staff reported that when they were short-staffed, they were unable to provide showers, bed baths, or even regular oral care as required. Residents confirmed that they did not receive showers or bed baths as scheduled, sometimes going weeks without proper hygiene care. They also reported significant delays in response to call lights, particularly during night shifts, with some residents waiting hours for assistance. Review of staffing schedules and shower documentation over a two-week period confirmed multiple instances where no showers were provided due to insufficient staffing and the absence of a shower nurse. The Director of Nursing acknowledged that the facility is required to provide care and showers regardless of staffing levels, and the facility's policy stated that appropriate care and services must be provided for residents unable to perform ADLs independently.