Insufficient CNA Staffing During Night Shifts
Penalty
Summary
The facility failed to provide a sufficient number of certified nursing assistants (CNAs) to meet the basic care needs of all residents, as required. Review of staffing records, daily assignment sheets, and timecards for multiple dates revealed that the number of CNAs scheduled and present during night shifts was consistently below the facility's own documented staffing requirements. On several occasions, only one CNA was present to care for as many as 53 residents on a locked behavioral unit, and there were instances where only one CNA was available for entire wings, despite the facility assessment indicating a high level of resident dependency for activities of daily living and behavioral health management. Interviews with staff, including CNAs, LPNs, and RNs, confirmed that the facility was often short-staffed, particularly during night shifts. Staff reported that agency CNAs did not always show up for their scheduled shifts, and replacements were not consistently found. As a result, incontinence care and other basic needs were not always provided in a timely manner, and staff had to catch up on care at the start of the next shift. Staff also expressed concerns about the ability to supervise residents with behavioral issues and those who wander, given the inadequate staffing levels. The facility's human resources director and clinical scheduler acknowledged the staffing shortages and confirmed that the facility relies on agency staff to supplement their workforce. However, there was no formal guideline or formula used for scheduling, and the scheduler was sometimes unaware when staff did not show up for their shifts. The facility's own assessment tool documented the need for more CNAs per shift than were actually present, and the staffing records reviewed for March and April confirmed the accuracy of the reported shortages.