Insufficient CNA Staffing on Night Shifts
Penalty
Summary
The facility failed to provide a sufficient number of nursing staff, specifically Certified Nursing Assistants (CNAs), on a 24-hour basis to meet the needs of all residents in accordance with the facility assessment and resident care plans. On multiple dates, the facility operated with only one CNA on the night shift (10 PM-6 AM), despite a resident census that exceeded the staffing ratio outlined in the facility assessment, which required at least one CNA per 30 residents. Census records showed that on the dates in question, the number of residents ranged from 44 to 49, but only one CNA was scheduled for the night shift. Interviews with staff members revealed that working short-staffed was a recurring issue, with some staff reporting that they were the only CNA for the entire building during certain shifts. Staff described difficulties in providing timely care, with residents having to wait for assistance and some care tasks being delayed. Staff also reported that the shortage of CNAs led to situations where mechanical lifts were used without the required assistance, as nurses were not always available to help. Staff consistently stated that management was aware of the staffing shortages and the challenges in meeting residents' needs. The Director of Nursing (DON) and the Administrator acknowledged the staffing challenges, with the DON stating that the facility often operated below the planned CNA staffing levels for each shift. The Administrator indicated that the facility assessment allowed for one to two CNAs on the night shift, depending on census, and that the direct care staff ratio was intended to be one CNA per 30 residents. Despite this, time sheets confirmed that only one CNA was present on the night shift during the dates reviewed, even when the census exceeded 30 residents. The facility's policy required sufficient nursing staff to ensure resident safety and well-being in accordance with care plans and the facility assessment.