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 all residents, as evidenced by both direct observations and review of staffing records. Multiple instances were documented where residents were not assisted with care in a timely manner, including prolonged wait times for call bells to be answered and persistent odors of urine and feces in hallways and common areas. These observations indicated that residents were not receiving prompt personal care, and staff were unable to respond to requests for assistance as needed. Staffing sheets reviewed for the period showed that the number of licensed nurses and Certified Nurse Aides (CNAs) scheduled consistently fell short of the facility's own staffing plan and the calculated hours of care required based on census. On several days, there were not enough licensed nurses or CNAs scheduled to meet the minimum required hours of care per resident per day. In some cases, nurse supervisors had to take on direct care assignments due to insufficient staffing, and on one occasion, a unit had no nurse scheduled at all. The shortfall in staffing was present across multiple shifts and units, with the greatest deficits noted on evening shifts and weekends. Interviews with staff further confirmed the impact of inadequate staffing. CNAs and nurses reported being unable to complete all required tasks, with care being limited to essential activities such as feeding and changing residents. Staff described difficulty in providing timely assistance, especially for residents requiring two-person assistance, and noted that paperwork and care plan reviews were not completed as thoroughly as needed. The Director of Nursing acknowledged ongoing staffing challenges and described efforts to recruit and repurpose staff, but also indicated that some nurses were overburdened with multiple roles.