Inadequate Staffing in Hospice Specialty Unit
Penalty
Summary
The facility failed to provide sufficient and appropriately deployed nursing staff to meet the needs of all residents in the designated Hospice Specialty Unit. Observations revealed that the unit was staffed with only one LPN and one nurse aide for ten residents, many of whom required high levels of care, including assistance with feeding, transfers, and mobility. During periods when the nurse aide was on break, the LPN was left alone to supervise and care for all residents, resulting in unsupervised common areas and delayed responses to call bells and alarms. On multiple occasions, residents identified as fall risks were observed attempting to stand unassisted while staff were occupied elsewhere. Interviews with staff confirmed that there was no system in place to provide relief coverage during staff breaks, leaving the unit understaffed and residents unsupervised. Staff reported that the acuity of the residents, including the need for two-person assistance for transfers and feeding, was not adequately considered in staffing assignments. There were instances when both staff members were required to assist a single resident, leaving other residents unattended and alarms unanswered. Additionally, there were times when only one staff member was present on the unit, and on one occasion, no LPN was assigned, requiring staff from another unit to cover both areas. The Director of Nursing and the Nursing Home Administrator acknowledged that staffing levels did not account for the high acuity of the hospice residents and were insufficient to meet their needs. Staff also reported that inadequate staffing during critical periods, such as when a resident was actively dying, prevented them from providing necessary emotional support to families, as they were occupied with routine care and responding to call bells. The facility's failure to ensure adequate staffing directly impacted the quality and timeliness of care, supervision, and services provided to the hospice residents.