Insufficient Nursing Staff Leads to Delays in Resident Care and Medication Administration
Penalty
Summary
The facility failed to provide sufficient nursing staff on two resident units, resulting in delays in morning activities of daily living (ADL) care and medication administration. On the Lake Unit, there were only three CNAs assigned to care for 42 residents during the day shift, which was below the required staffing level. Observations showed that a resident with a history of traumatic brain injury, dementia, dysphagia, and weakness experienced significant delays in receiving assistance with eating and morning care. Staff interviews confirmed that the reduced number of CNAs led to late completion of ADL care, with some residents not out of bed before lunch and showers being postponed. The CNAs reported being unable to complete all required tasks in a timely manner due to the staffing shortage, and the late care was not due to resident preference but rather insufficient staff coverage. The facility's staffing schedule and interviews revealed that the required number of CNAs for the day shift was not met, and there was a lack of effective response to staff callouts. The scheduler acknowledged that resident acuity was not considered when determining staffing needs and that attempts to fill callout spots were limited. The Director of Nursing stated that the Lake Unit was typically staffed with three CNAs, and a fourth would be added if needed, but was unaware of any issues with timely completion of care when staffed with three CNAs. Additionally, a Resident Care Assistant was also absent, and this was not known to the DON until later in the day. The facility's process for redistributing staff and responding to callouts was insufficient to ensure adequate coverage. Medication administration was also delayed on both the Lake and Tapestry Units. Nurses reported being very late with medication passes due to having to stop and assist with other resident care tasks, such as delivering breakfast trays, feeding residents, answering call lights, and toileting. On the Tapestry Unit, nurses and CNAs had to frequently redirect wandering residents and assist with feeding, further delaying medication administration. The DON was aware that resident behaviors could cause delays but stated that staffing was based on ratios managed by the scheduler. The scheduler confirmed that she was unable to call additional staff to cover callouts due to being pulled to work as a CNA herself. These staffing shortages and lack of timely response to absences directly contributed to the deficiencies in resident care and medication administration.