Failure to Maintain Sufficient Nursing Staff per Facility Assessment
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents as outlined in its Facility Assessment. The assessment specified that each shift required 14 CNAs, 6 licensed nurses providing direct care, and 5 other nursing personnel with administrative duties. However, review of staff assignment sheets over several days showed that these staffing levels were not consistently met, with multiple shifts falling short of the required number of CNAs and licensed nurses. Staff interviews confirmed that these shortages resulted in unmanageable workloads, with CNAs and LPNs reporting that they were unable to complete 30-minute rounds or provide timely assistance to residents. Some staff were responsible for as many as 23 residents, and there were instances where units operated without a CNA, making it difficult to meet residents' needs and pass medications on time. Further interviews with staff, including the DON and administrative personnel, confirmed awareness of the staffing requirements in the Facility Assessment and acknowledged that the facility was not staffed according to these requirements during the reviewed period. Staff responsible for making assignments were unaware of the Facility Assessment's staffing requirements, leading to continued non-compliance. The deficiency had the potential to affect the entire resident census of 153, as the facility was unable to ensure that nursing and related services were provided to maintain the highest practicable well-being of each resident.