Insufficient Weekend Nursing Staff Coverage
Penalty
Summary
The facility failed to ensure sufficient nursing staff were available on weekends, as evidenced by a review of Payroll-Based Journal (PBJ) staffing data and staff interviews. PBJ data showed that weekend staffing levels were consistently lower than weekday staffing during two fiscal quarters. On specific weekends, scheduled staffing was not met due to multiple callouts, particularly among nursing aides. For example, on one Sunday, six nursing aides called out for the 7-3 PM shift, and only one could be called in, resulting in six aides working instead of the scheduled ten. Similarly, for the 3-11 PM shift, five aides called out, and only three could be called in, leaving the shift short-staffed for several hours. The facility did not provide documentation to demonstrate that resident care needs were met during these periods of reduced staffing. Interviews with the scheduler and administrator confirmed that callouts, including those due to inclement weather, contributed to the staffing shortages. The facility's staffing plan, as outlined in the Facility Assessment, called for 11 nursing aides for the 7-3 PM shift with an average daily census of 83 residents. The assessment also identified staffing as a weakness, citing a unionized workforce and limited availability of per-diem or temporary staff. The administrator was unaware that the facility had been flagged for low weekend staffing in PBJ reports and acknowledged that the facility was not utilizing agency staff during the periods in question. Additionally, the DNS and ADNS occasionally filled in as RN supervisors but did not clock in as direct-care staff.