Deficiency Due to Insufficient Nursing Staff and Delayed Resident Care
Penalty
Summary
The facility failed to provide sufficient nursing staff with the appropriate competencies and skill sets to meet the needs of all residents, as determined by resident assessments and individual care plans. Observations revealed that during multiple shifts with a resident census of 51, only two CNAs and three nurses were present, despite the regular staffing pattern calling for three CNAs per shift. This staffing shortage led to missed showers, delayed response to call lights, and delayed incontinent care for dependent residents. Multiple residents and family members reported waiting 20-30 minutes or more for assistance, with some residents left wet for extended periods. Interviews with residents, family members, CNAs, and nurses consistently described the impact of insufficient staffing. Residents reported long wait times for call light responses and care, with CNAs rushing to provide assistance due to their workload. Staff confirmed that rounds could not be made every two hours as required, and that showers were often missed or delayed. CNAs were assigned up to 18-19 residents each, making it difficult to provide timely care, including incontinence checks and assistance with activities of daily living. Staff also reported high turnover and that the facility had been short of CNAs for several weeks to months. Review of staffing schedules and grievance records corroborated the ongoing staffing issues. The facility's schedules showed multiple instances where only two CNAs were scheduled instead of the required three. Grievance forms documented complaints from residents, families, and staff about understaffing, delayed call light responses, and inadequate care. The Executive Director acknowledged the CNA shortage and attributed it to staff leaving for higher pay, but was not aware of specific concerns related to delayed care. There was no policy or procedure on staffing, and grievances were sometimes left unresolved or only addressed through staff re-education.