Insufficient Staffing Leads to Missed Resident Showers and Hygiene Care
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents, as evidenced by multiple interviews, record reviews, and policy review. Certified nurse aides reported that there were not enough staff to complete essential activities of daily living (ADL) care, including showers and hygiene tasks. Staff described working without breaks, working overtime to complete charting, and being unable to provide showers or baths according to residents' preferences due to inadequate staffing levels. The Director of Nursing confirmed that the facility did not meet the minimum direct care daily average of 2.5 hours per resident per day on several dates, and the facility assessment had not been updated since April 2022. Three residents were specifically affected by the staffing deficiency. One resident, with severe cognitive impairment and total dependence on staff, preferred tub baths three times a week but often received bed baths instead, and there was no documented evidence of regular bathing or showers in the electronic medical record. Another resident, fully dependent for transfers and requiring a mechanical lift, preferred a weekly bath but had incomplete or missing documentation for showers and baths, with only two days marked as completed in the electronic record. A third resident, also fully dependent on staff for bathing and with a history of depression, had inconsistent documentation of showers and bed baths, and some shower sheets were not filled out. The facility's policy required assisting residents with bathing and maintaining proper hygiene according to their preferences, but this was not consistently followed. The lack of sufficient staffing directly impacted the ability to provide care as planned and documented, affecting residents' ability to receive showers or baths as preferred and required. The deficiency was identified through interviews with staff and residents, review of staffing schedules, and examination of care documentation.