Failure to Provide Sufficient Nursing Staff and Meet Resident Care Needs
Penalty
Summary
Facility staff failed to maintain sufficient nursing staff to meet the needs of a resident with hemiplegia and moderate cognitive impairment. On one occasion, the resident did not have their hands washed before eating, and feeding assistance was provided while the CNA stood rather than sat, which made the resident uncomfortable. The CNA responsible stated that the unit was short staffed, requiring them to hurry and manage multiple tasks, including delivering trays and feeding residents, which contributed to the observed deficiencies in care. Review of staffing schedules and interviews with staff confirmed that the LTC unit was not consistently staffed according to facility requirements. On the day in question, a CNA was reassigned between units due to staffing shortages, resulting in the LTC unit being left short staffed. The staffing coordinator acknowledged that short staffing can affect resident care and described efforts to cover call outs, but also confirmed that the unit was not fully staffed during the shift in question. Additionally, the resident did not receive a scheduled bath as documented in their care plan. Review of the point of care documentation showed a missed shower, and staff interviews confirmed that the evening shift was short staffed, making it difficult to provide proper care. The facility's assessment indicated that staffing decisions should be based on resident needs and unit requirements, but the observed staffing levels did not meet these standards, resulting in unmet care needs for the resident.