Failure to Provide Sufficient Nursing Staff for Timely Call Bell Response
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of residents, specifically regarding timely response to call bells for assistance with toileting. One resident, who was cognitively intact and occasionally incontinent, reported waiting up to an hour for help to use the bathroom, resulting in incontinence and embarrassment. The resident also noted that an LPN would turn off the call bell and state they would notify a nurse aide, but no one would return to assist. A grievance was filed by this resident regarding the incident, but there was no documented resolution, and call bell audits were not conducted until nearly two weeks later. Another resident, who was frequently incontinent of bladder, expressed ongoing concerns about insufficient staffing, stating that delays in call bell response occurred on all shifts and often resulted in waiting over 30 minutes for assistance. Both residents' concerns were confirmed through interviews and clinical record reviews. These findings were discussed with facility leadership, and the lack of timely response was attributed to inadequate staffing levels.