Failure to Provide Adequate Staffing and Timely Resident Care
Penalty
Summary
The facility failed to provide sufficient nursing staff to meet the needs of all residents, resulting in multiple deficiencies across several units. Two residents were observed to have not received timely incontinence care, with one resident remaining unchanged and un-repositioned for over 10 hours, resulting in saturated bedding and visible skin redness. Another resident, who was nonverbal and totally dependent on staff, was found with two saturated incontinence briefs and a wound dressing soaked with urine and bloody drainage. Staff interviews confirmed that incontinence care was not provided as required, and that staff shortages contributed to the lack of care, with CNAs responsible for an excessive number of residents per shift. Medication administration practices were also deficient. One resident was found with a medication cup containing four tablets left unattended at the bedside for over three hours after the MAR had been initialed as administered. The resident was unable to reach the medication due to weakness, and staff interviews confirmed that medications should not be left unattended and that the nurse failed to ensure the resident swallowed the medications before documenting administration. The facility's policy prohibits leaving medications in resident rooms or unattended on the medication cart. Additionally, the facility failed to maintain cleanliness and respond to resident needs in a timely manner. A strong odor of feces and vomit was noted in a resident room, with one resident reporting that the smell persisted overnight and that staff had not cleaned the bedside commode or removed vomit from the garbage can. Staff confirmed awareness of the issue but cited workload and staffing shortages as reasons for not addressing it. Review of staffing records revealed that the facility did not consistently meet New Jersey's minimum CNA staffing requirements on multiple day shifts, with several days falling below the mandated ratios.