Failure to Provide Sufficient Nursing Staff and Timely Care
Penalty
Summary
The facility failed to provide a sufficient number of nursing staff on a 24-hour basis to meet the care needs of all residents, as required by resident care plans and the facility assessment. On multiple occasions, medication administration for a resident with Parkinson's disease and other conditions was delayed beyond the scheduled time window, and in some cases, doses were not administered as ordered. Staff interviews revealed that these delays and omissions were due to short staffing, with medication aides and nurses reporting being the only staff available to administer medications during certain shifts. Documentation showed that staff did not always notify the physician or DON when medications were given late or missed, and some staff admitted to marking medications as given in the MAR without actually administering them. Another resident, who required substantial assistance with bathing due to impaired balance and other health issues, reported not receiving scheduled showers on Saturdays. Staff interviews confirmed that showers were sometimes missed due to short staffing, particularly on weekends. Staff described working across multiple areas of the building and being unable to complete all required care tasks. The facility's own assessment indicated a need for a specific number of CNAs per shift, but staffing records showed that these levels were not consistently met, especially on weekends and night shifts. A third resident, who was cognitively intact but required total assistance with mobility and ADLs, reported not being able to get out of bed as requested, particularly on weekends when staffing was low. Staff confirmed that there were times when only one or two aides were available for the entire building, making it difficult to provide timely care. Management interviews revealed a lack of awareness of the facility's staffing requirements and no policy for staffing, despite the facility assessment specifying minimum staffing levels. Review of staffing records over several months showed repeated instances where the number of CNAs and medication aides fell below the assessed requirements.