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F0677
D

Failure to Provide Timely ADL Assistance Due to Inadequate Staffing

Bloomfield, Nebraska Survey Completed on 11-18-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to provide timely assistance with Activities of Daily Living (ADLs) to a resident who required help due to self-care deficits, limited mobility, and a history of dizziness and arthritis. The resident's care plan specified the need for assistance with ambulation, bathing, toileting hygiene, transferring, and clothing adjustment, with a preference for bathing twice weekly during the summer. However, records showed inconsistent bathing schedules, with gaps of up to two weeks between baths, and multiple instances where call light response times exceeded the facility's stated standard of 10 minutes, including one instance where the response time was over 50 minutes. Interviews with the resident and their family member revealed ongoing concerns about insufficient staffing, particularly during day and evening shifts and on weekends, leading to delays in care and unmet personal hygiene needs. The resident reported feeling unsafe when forced to attempt self-care due to long wait times and expressed dissatisfaction with the frequency of bathing and call light responses. The Director of Nursing confirmed that the facility was not meeting its own nurse aide staffing levels as posted, which contributed to the deficiencies in providing timely and adequate ADL assistance.

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