Failure to Meet Minimum Staffing Ratios and Direct Care Hours
Penalty
Summary
The facility failed to meet required nurse aide (NA) staffing ratios on multiple occasions, as evidenced by a review of nursing schedules, staffing information, and staff interviews. Specifically, there were eight days where the day shift did not meet the minimum of one NA per 10 residents, four days where the evening shift did not meet the minimum of one NA per 11 residents, and nine days where the night shift did not meet the minimum of one NA per 15 residents. On these days, the number of NAs scheduled was consistently below the required ratios based on the facility census, and no additional higher-level staff were available to compensate for the shortfall. The Nursing Home Administrator confirmed that all staffing hours were provided as documented and acknowledged the failure to meet the required ratios on the specified days. Additionally, the facility did not meet the minimum required Licensed Practical Nurse (LPN) staffing ratios for the night shift on two days. The census data indicated that the number of LPNs scheduled was below the required minimum of one LPN per 40 residents for the night shift, and again, no excess higher-level staff were available to make up for the deficiency. The Nursing Home Administrator confirmed the shortfall in LPN staffing for the identified days. The facility also failed to provide the minimum required hours of direct resident care per day for nine days within the review period. The nursing time schedules showed that the facility provided less than the required 3.20 hours of direct care per resident on these days, with the lowest being 2.84 hours. The Nursing Home Administrator confirmed the accuracy of the staffing information and acknowledged that the facility did not meet the required daily direct care hours on the specified days.
Plan Of Correction
There is no evidence that any resident was adversely affected. Current residents have the potential to be affected. The facility will schedule, monitor, and manage the nursing assistant staff ratios to meet the requirements. To prevent recurrence, the Nursing Home Administrator will review the required ratios with the Director of Nursing and other staff responsible for nursing staff scheduling. Daily staffing meetings will be held to review the scheduled staffing ratios and hours per patient day for the upcoming day(s) to ensure the facility plans to meet the requirements. To maintain and monitor compliance, the Nursing Home Administrator/designee will conduct audits of the nursing assistant staffing ratios to determine minimums were met weekly x4 and monthly x2. Results of the audits will be forwarded to the center Quality Assurance Performance Improvement committee for review and recommendations. There is no evidence that any resident was adversely affected. Current residents have the potential to be affected. The facility will schedule, monitor, and manage the hours per patient day to meet the requirements. To prevent recurrence, the Nursing Home Administrator will review the required ratios with the Director of Nursing and other staff responsible for nursing staff scheduling. Daily staffing meetings will be held to review the scheduled staffing ratios and hours per patient day for the upcoming day(s) to ensure the facility plans to meet the requirements. To maintain and monitor compliance, the Nursing Home Administrator/designee will conduct audits of the hours per patient day to determine minimums were met weekly x4 and monthly x2. Results of the audits will be forwarded to the center Quality Assurance Performance Improvement committee for review and recommendations.