Insufficient Nursing Staff Resulting in Delayed Resident Care and Unmet Needs
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of its residents, as evidenced by multiple resident interviews, staff interviews, observations, and record reviews. Several residents reported excessive wait times for call light responses, with some waiting up to three hours for assistance with toileting and other needs. One resident, who takes a diuretic, reported being unable to use a urinal for up to three hours, while another resident with a recent above-the-knee amputation described being left in a wet bed and not receiving timely toileting assistance. Additional residents reported being told to soil themselves due to lack of available staff, and one resident experienced incontinence and humiliation after waiting an hour and a half for help during a diarrhea episode. Observations in the dining room revealed that only one CNA was present to assist seven residents during breakfast, resulting in delays in feeding assistance and residents receiving cold food. Two residents who required feeding assistance had to wait until all other residents were served, and another resident repeatedly requested water but did not receive it because the CNA was occupied. The CNA confirmed that staffing was insufficient in the dining room, as CNAs were required to cover both the dining room and resident units, leading to delays in care and unmet needs. A review of the facility's staffing schedules and Facility Assessment showed that staffing levels frequently fell below the recommended ratios based on resident acuity and census. On several occasions, there were only two staff members (one CNA and one LPN) available for over 50 residents during the night shift, resulting in staffing hour ratios as low as 2.51, which was below the facility's own assessment guidelines. The Nursing Home Administrator acknowledged that staffing levels were not consistently maintained according to the facility's assessment and resident needs.