Failure to Accurately Update and Post Daily Nurse Staffing Information
Penalty
Summary
The facility failed to ensure that daily posted nurse staffing information accurately reflected the actual number of nursing staff and the hours worked during three of four overnight shifts reviewed. According to the facility's own assessment, one to two licensed nurses and three to four CNAs were needed on the overnight shift to meet resident needs. However, interviews and time sheet reviews revealed that on several occasions, fewer staff were present than indicated on the posted staffing information. For example, on certain nights, only one LPN and two CNAs were present to care for 75 residents, despite postings indicating higher staffing levels. A review of posted staffing information for specific dates showed that the postings included the type and number of direct care staff and their hours worked. However, comparison with actual time sheets revealed discrepancies: on some nights, staff left their shifts early and did not return, and additional staff arrived only in the early morning hours to support the overnight and oncoming day staff. The posted information was not updated to reflect these changes, as required by facility policy, which states that actual hours must be updated if there are any changes to the schedule, number of staff, or hours worked after the start of each shift. The deficiency was further compounded by a lack of clear responsibility for updating the staffing postings. The staffing coordinator position had been vacant since April, and the unit manager who had assumed the responsibility left at the end of May. The administrator acknowledged that she had not taken over or delegated the task after the unit manager's departure, resulting in the failure to update the posted staffing information to accurately reflect actual staffing during the reviewed overnight shifts.