Failure to Provide Sufficient Nursing Staff for Resident Care Needs
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the daily needs of all residents, as evidenced by the absence of Certified Nursing Assistants (CNAs) on duty during a specific shift and lack of documentation for care provided. Medical record reviews for three residents with significant care needs, including diagnoses such as obstructive hypertrophic cardiomyopathy, myasthenia gravis, schizophrenia, Parkinson's disease, and adult failure to thrive, revealed gaps in documentation of activities of daily living (ADL) care, particularly between 3:00 P.M. and 7:00 P.M. on a specified date. For these residents, task sheets showed either no documentation or infrequent documentation of personal hygiene and toileting assistance, despite their dependence on staff for these tasks. Interviews with residents, their representatives, and staff confirmed ongoing staffing shortages, especially the absence of CNAs during the identified shift. Residents and their representatives reported delays in call light responses, unmet care needs, and instances where residents remained in soiled briefs or received late medications. Staff interviews corroborated these accounts, with LPNs and CNAs stating that they sometimes worked without adequate support, leading to prioritization of care and difficulty fulfilling all resident needs. The facility's own assessment tool outlined required CNA-to-resident ratios for each shift, which were not met during the period in question. Timecard reviews confirmed no CNAs were present during the critical hours, and the administrator was unable to verify that required care was provided outside of what was documented. Multiple complaints and interviews further substantiated the deficiency in staffing and the resulting lack of timely and adequate care for residents.