Insufficient Nursing Staff and Lack of Coverage on Night Shift
Penalty
Summary
The deficiency involves the facility’s failure to ensure sufficient nursing staff on all shifts to meet residents’ needs and to have a licensed nurse in charge on each shift. Resident council minutes documented that residents reported a need for more night staff. A daily staffing sheet for a specific date showed that only one RN (identified as V21) was working the entire midnight shift for a census of 80 residents, despite the staff scheduler stating that, based on census and level of care, there should have been two nurses on that shift. The staff coordinator/scheduler (V22) reported that when the evening nurse’s relief did not arrive, she instructed the evening nurse to stay, but the nurse refused, and despite offering bonuses, no additional nurse could be obtained. V22 stated she is a CNA and could not perform nurse duties, and there was no other nurse available to cover the shift. Multiple cognitively intact residents reported that staffing was inadequate, especially at night, and that call lights took a long time to be answered. One resident stated the facility had problems with staffing and needed to hire more staff; another stated there were no staff and it was worse on nights, and another reported staff told them they were short and that it took a long time to receive care. A CNA confirmed that V21 was the only nurse in the building for the entire night shift. V21 stated he was the only nurse for the entire building from around 11 p.m., that the evening nurse left despite his refusal to cover the hall alone, and that his attempts to contact management for assistance went unanswered. He described the night as challenging, with residents experiencing changes in condition requiring hospitalization and no additional nursing help. Another cognitively intact resident reported that staffing was bad and slow, that the facility relied heavily on agency staff who might not show up, leaving residents without care or with poor care. The DON stated the facility did not have a staffing policy, while the administrator stated the facility followed CMS regulations.
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