Delay in Peri Care Due to Staffing Shortage
Penalty
Summary
A deficiency occurred when a resident who was unable to perform activities of daily living did not receive timely assistance with personal hygiene and grooming. The resident, a male with multiple diagnoses including alcoholic cirrhosis of the liver, acute respiratory failure, chronic kidney disease, hypertension, dependence on renal dialysis, and syncope, had a moderately impaired cognitive status as indicated by a BIMS score of 8. On the morning in question, the resident experienced bowel and bladder incontinence at 6:30am and requested peri care multiple times using the call light. Despite repeated requests, the resident waited approximately four hours before a CNA was able to provide the necessary care. During this period, staff responded to the call light only to turn it off and inform the resident that assistance would arrive soon. The delay in care was attributed to staffing shortages, as one of the two CNAs assigned to the hallway called in sick and no replacement was available. The remaining CNA was responsible for additional residents, including one with a dialysis appointment, which further delayed response times. Facility leadership, including the DON and administrator, confirmed that the lack of a substitute CNA led to the delay in providing care. Facility policies reviewed emphasized the right of residents to be free from neglect and to receive care that maintains dignity and hygiene, which was not upheld in this instance.