Failure to Maintain Sufficient Direct Care Staffing
Penalty
Summary
The facility failed to provide sufficient direct care staff to meet the needs of all residents, as evidenced by a period on a specific day when only one Certified Nursing Assistant (CNA) was available to care for 46 residents. The facility's own assessment indicated that an average of five CNAs were required to meet resident needs, and staffing was to be adjusted daily based on census and acuity. However, documentation and interviews confirmed that between 12:19 P.M. and 2:11 P.M. on the day in question, only one CNA was present, resulting in significant delays in responding to call lights and providing assistance with activities of daily living (ADLs), including toileting and bathing. The CNA on duty reported being unable to answer most call lights in a timely manner, with some residents waiting up to an hour for assistance, and was unable to provide scheduled showers or baths. Multiple residents with complex medical conditions, such as multiple sclerosis, chronic kidney disease, Parkinson's disease, and mobility impairments, were directly affected by the staffing shortage. Residents reported waiting extended periods for assistance with toileting, leading to episodes of incontinence and feelings of humiliation. For example, one resident's call light remained unanswered for over 36 minutes, and another resident waited over 52 minutes for help, ultimately resulting in a bowel movement before staff arrived. Residents also reported missing scheduled showers and being unable to participate in facility activities due to lack of timely assistance. Documentation, such as call light audit reports and shower logs, corroborated these accounts. Interviews with staff, including the DON and Administrator, confirmed the staffing shortfall and acknowledged that several residents required two-person assistance for ADLs, which could not be provided with only one CNA on duty. The DON stated that another CNA had been scheduled but was running late, and acknowledged that nurses should have assisted with resident care during the shortage. Residents and staff expressed frustration with the lack of timely response to call lights and unmet care needs, and facility records showed that concerns about staffing and call light response times had been raised by residents but were not adequately addressed.