Failure to Ensure Adequate Direct Care Staffing, Hydration, Hygiene, and Call Light Response
Penalty
Summary
The deficiency involves the facility’s failure to ensure adequate direct care staffing and to operationalize a facility assessment that specified the number of direct care staff needed daily to meet resident needs. The facility’s assessment tool referenced an addendum for direct care staffing needs, but no such addendum existed, leaving the facility without a defined staffing plan for direct care staff. The Director of Nursing later stated that specific numbers of CNAs were needed on each shift to meet resident needs, and confirmed that the facility was unable to staff those minimum numbers on multiple days. Review of CNA schedules and time sheets for selected dates showed that the number of CNAs actually working on day and night shifts was below the stated minimums. The facility also failed to provide scheduled showers and basic hygiene as outlined in residents’ care plans and facility policies. Multiple residents had care plans and MDS assessments indicating dependence on staff for showers and personal hygiene, as well as preferences or schedules for showers on specific days. Documentation showed missed showers on scheduled days, including one resident whose shower report explicitly cited lack of staff as the reason a scheduled shower was not given. Another resident submitted a written concern stating they were not getting showers and that it had been another whole week without one. During observations, residents were noted with long, jagged fingernails and reported not receiving showers or nail care as expected. The facility further failed to follow its hydration policy requiring fresh cold ice water to be provided to each resident at least three times daily. During tours of all four hallways, no residents were observed with fresh ice water at the bedside, and several residents reported they did not receive fresh ice water every shift or at all, and that they had to save water from meals to have water in their rooms. Residents also reported that call lights often remained on for long periods, sometimes over an hour, before being answered. Multiple CNAs, LPNs, and RNs consistently reported that there were not enough CNAs on various shifts, that showers and ice water passes were frequently not completed, and that call lights could not be answered promptly due to low staffing, including reports of nights with only one or two CNAs for the entire building. These observations, interviews, and record reviews collectively show that the facility did not ensure adequate numbers of direct care staff to complete daily ADLs such as showers, nail care, hydration, and timely response to call lights for the 58 residents in the building. The failures occurred despite facility policies requiring at least weekly bathing and a minimum of three daily fresh ice water passes, and despite care plans directing staff to encourage oral fluids and maintain fresh ice water at the bedside for residents with urinary alterations and risk for dehydration.
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