Failure to Provide Adequate Staffing for Resident Care Needs
Penalty
Summary
The facility failed to provide adequate nursing staff to meet the needs of all residents, as evidenced by multiple instances of residents arriving late to scheduled in-house dialysis treatments. Medical record reviews and staff interviews revealed that several residents with end stage renal disease or chronic kidney disease, who required regular dialysis, were consistently late for their treatments. Documentation showed delays ranging from over an hour to nearly three hours, with staff and residents attributing these delays to insufficient staffing. The facility's own assessment indicated a need for 28 CNAs daily, but staffing records showed significantly fewer CNAs scheduled on the days when residents were late for dialysis. In addition to dialysis delays, the facility did not consistently provide scheduled showers to residents who required assistance. Review of shower schedules and documentation for several residents revealed that showers and baths were missed or infrequently provided, with some residents receiving only two or three showers over a month-long period. Staff interviews confirmed that inadequate staffing contributed to the inability to complete scheduled showers, and documentation was lacking for missed or refused showers. The facility also failed to provide necessary respiratory therapy staffing to support a resident's ventilator weaning process. A resident with a tracheostomy and mechanical ventilator had physician orders for a gradual weaning process at night, requiring close supervision by respiratory therapy. However, staff schedules and interviews confirmed that no respiratory therapist was present on several nights, and floor nurses were not trained to perform ventilator weaning. As a result, the resident was not making progress in the weaning process due to the lack of appropriate staff coverage.