Failure to Provide Sufficient Nursing Staff Results in Delayed Care and Late Medication Administration
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents in a timely manner, as evidenced by multiple incidents involving delayed care, unmet toileting needs, and late medication administration. Several residents with significant cognitive and physical impairments, including those with dementia, incontinence, and mobility deficits, were not assisted promptly with toileting or hygiene, resulting in episodes of incontinence and prolonged exposure to urine and feces. Staff interviews confirmed that there were often not enough CNAs on duty, particularly during evening and night shifts, leading to delays in responding to call lights and providing necessary assistance. Family members and residents reported instances where residents had to wait extended periods for care, sometimes sitting in soiled clothing or bedding. Medication administration was also negatively impacted by insufficient staffing. Multiple residents received their medications, including critical diabetes and heart medications, late on several occasions. Nursing staff, including RNs and LPNs, reported that high workloads, the need to assist with direct care, and interruptions during medication passes contributed to these delays. Agency staff unfamiliar with residents and facility routines further exacerbated the problem, with some agency CNAs reportedly leaving their posts for extended periods during shifts. Facility records and staff schedules revealed that the number of CNAs on duty frequently fell below the facility's stated minimums, especially on night shifts, with as few as two or three CNAs responsible for up to 74 residents. The Director of Nursing acknowledged discrepancies in staffing records and confirmed that licensed nurses were expected to assist with direct care when CNA staffing was insufficient. However, this expectation did not consistently result in timely care for residents, as documented by both staff and resident accounts.