Failure to Provide Sufficient Nursing Staff to Meet Resident Needs
Penalty
Summary
The facility failed to provide sufficient nursing staff each day to meet the needs of every resident, as required by regulation. Multiple reviews of daily staffing logs and corresponding time sheets over a three-month period revealed frequent discrepancies between the facility's reported staffing levels and the actual number of staff present. On numerous occasions, the number of staff working was less than what was documented on the staffing logs and below the facility's own minimum staffing plan, as outlined in the facility assessment. These discrepancies affected all shifts, including day, evening, and night, and occurred while the facility census ranged from 62 to 68 residents. Interviews with staff and administration further confirmed the staffing shortages. Several CNAs reported working alone on their assigned halls, which prevented them from providing scheduled showers or ensuring resident safety when attending to other residents. One CNA stated she worked alone on the hall three to four times a month and could not provide showers under those circumstances. Another CNA expressed concern about being unable to monitor residents for safety, especially when caring for one resident left others unsupervised. An LPN reported being responsible for two halls and wound care, indicating an excessive workload due to insufficient staffing. The Maintenance Director also noted that there should always be two staff members on the secured unit, but this was not consistently the case. The facility was also without a Director of Nursing (DON) for nearly a month, as confirmed by the Administrator, which further contributed to the staffing challenges. The Administrator acknowledged that the facility did not have enough staff and identified staffing as the root cause of issues such as elopements, incomplete treatments, and missed showers. The facility's own policy stated that sufficient numbers of staff with the necessary skills and competency would be provided to meet all residents' needs, but this was not consistently achieved during the period reviewed.