Failure to Maintain Sufficient Nurse Staffing on Multiple Shifts
Penalty
Summary
The facility failed to provide sufficient numbers of nurse aides and licensed nurses on a 24-hour basis to meet the needs of all residents, as required by posted nurse staffing levels and resident care plans. Over a period of several days, staffing schedules and time punches revealed repeated shortfalls in both nurse aides and licensed nurses on multiple shifts, with the facility consistently missing the required number of staff as indicated by their own posted staffing requirements. The resident census during this period was 58, and the facility assessment confirmed this average census. Despite the posted requirements, actual staffing often fell short, with some shifts missing up to two nurse aides and one LVN. Resident council minutes and interviews with residents indicated that call lights were not answered in a timely manner and that scheduled showers were sometimes missed. Multiple residents reported delays in receiving assistance and noted that staff were overworked, with some residents stating they had to remain in bed due to insufficient staff to assist them. Staff interviews corroborated these findings, with several staff members reporting chronic understaffing, frequent call-ins, and high turnover due to low pay and overwork. Staff also reported that nurses and therapy staff had to assist with direct care tasks to compensate for the lack of nurse aides, which in turn prevented them from completing their own duties, such as charting. The facility's own policy and facility assessment required staffing decisions to be informed by resident needs and census, and to include contingency planning for staffing shortages. However, interviews with the Director of Rehabilitation, acting administrator, and multiple staff members confirmed that the facility was unable to maintain adequate staffing, particularly when scheduled staff called in or did not show up. The issue was widely known among staff and residents, and the facility struggled to recruit and retain staff, with sign-on bonuses and pay rates cited as contributing factors. Observations during the survey period showed that, while care was being provided and call lights were answered promptly during the survey, this was not representative of typical staffing levels, as staff reported that the facility was only fully staffed due to the presence of surveyors.