Failure to Meet Minimum CNA Staffing Ratios on Day Shifts
Penalty
Summary
The facility failed to maintain the required minimum direct care staff-to-shift ratios as mandated by the state of New Jersey for 48 out of 63 day shifts reviewed. This deficiency was identified through interviews and a review of facility documentation, including staffing schedules for multiple periods. The state law requires one Certified Nurse Aide (CNA) for every eight residents during the day shift, but the facility consistently scheduled fewer CNAs than required for the number of residents present. Specific staffing shortfalls were documented across several weeks, with multiple day shifts where the number of CNAs on duty did not meet the minimum ratio. For example, on several occasions, there were only 13 to 15 CNAs scheduled for over 120 residents, when at least 15 or 16 were required. These deficiencies were present in all reviewed periods, including weeks in October, December, February, and April-May, with some periods showing every day shift falling below the required staffing level. During an interview, the staffing coordinator acknowledged awareness of the New Jersey staffing ratios and attributed short staffing primarily to last-minute call outs, though she stated it was rare for the facility to be short-staffed. The facility's own policy, revised in January, emphasized the need to provide sufficient staff to ensure resident safety and well-being, but the documented staffing levels did not align with these requirements during the reviewed periods.
Plan Of Correction
1. The daily staffing schedule was reviewed by the Human Resources Director to assure the facility is in compliance with the required minimum direct care staff-to-shift ratios. 2. All residents have the potential to be affected by the deficient practice. 3. The Human Resources Director will continue to post the vacancies on all 3 shifts. The Human Resources Director will continue to recruit through online platforms as well as a job fair. The Administrator will boost the rate when there is emergency staffing coverage. The facility is contracted with multiple staffing agencies for temporary and permanent staffing assistance. Employee Referral Bonus Program is in place. Bi-weekly meetings are held including the Administrator, Director of Nursing, Human Resources, staffing coordinator, and recruiter to review direct care staffing and develop strategies for recruitment and retention of direct care staff. In the event that we do not have the adequate ratio of staff on schedule or have call outs, the staff on shift are asked to stay for another shift as well as available coverage is requested from the facility's contracted staffing agencies at a boosted rate. 4. The Human Resources Director or designee will report the findings of completed direct care staff to resident ratio weekly audits to the Nursing Home Administrator as well as at the quarterly Quality Assurance and Performance Improvement meetings. The Quality Assurance Performance Improvement Committee will determine whether the audit needs to be continued or discontinued.