Failure to Provide Adequate Staffing and Timely Call Light Response
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents, as evidenced by multiple interviews and policy review. One resident reported waiting 2.5 hours for a response to her call light, using the wall clock to time the delay, and expressed frustration over being left in bed in the morning because there were not enough staff available to assist with her transfer, which required 2-3 staff members. Another resident confirmed experiencing extended wait times for staff to respond to call lights, with no particular time of day being worse than others. Certified Nursing Assistants (CNAs) interviewed acknowledged challenges in responding to call lights within the facility's 15-minute policy, citing being occupied in other resident rooms and overall staffing shortages. Staff attributed these issues to difficulties in hiring and retaining healthcare workers, as well as management decisions such as wage caps. The facility's call light policy, revised in September 2023, emphasizes prompt responses, but staff interviews indicated that timely responses were not consistently achieved.