Failure to Consistently Post and Maintain Required Daily Nurse Staffing Information
Penalty
Summary
The deficiency involves the facility’s failure to consistently post accurate daily nurse staffing information as required. On one survey date at 8:45 AM, the surveyor observed that no Staffing Data Daily posting was present at the front desk or anywhere in the facility. Later that day, the Nursing Home Administrator (NHA) stated there was no posting for that date because the Scheduler was not present. When the surveyor requested the last 30 days of Staffing Data Daily postings, the NHA later acknowledged that these postings could not be provided because the Scheduler did not retain them and shredded them daily, leaving no evidence of prior postings for comparison with staffing schedules. On a subsequent day, the surveyor observed that a Staffing Data Daily posting was present at the entrance front desk and on a hallway bulletin board, listing the date, census, and numbers of LPNs, RNs, CNAs, and an on-call DON for each shift. However, this posting did not include the facility name, staff per unit, shift times, or actual hours worked and/or total FTEs. During an interview, the Human Resources Assistant, who also functions as Scheduler, described typical shift times, minimum staffing requirements for each unit and shift, and the process for posting staffing data around 6:30 AM, including making written changes for census changes or call-ins. The Scheduler confirmed that postings are placed by the time clock, hallway bulletin board, front desk, and vent unit, and verified that postings were in those locations. The Scheduler also stated that postings are shredded daily and not kept, and that the NHA covers staffing postings when the Scheduler is absent, though the Scheduler had not yet taken vacation. On another survey date at 8:07 AM, the surveyor observed that the Staffing Data Daily postings at the hallway, front desk, and time clock were all dated several days earlier and that there had been no postings over the intervening weekend. The outdated posting also lacked the facility name, total hours worked, or FTEs per shift. At 8:44 AM that same day, there was still no updated posting for the current date, and the outdated posting remained in all locations. By 9:11 AM, an updated posting for the current date was observed, but it again did not include the facility name, total hours worked per shift, or FTEs per shift. In interviews, the Scheduler did not know who was responsible for weekend postings, and the NHA confirmed there were no policies or procedures for Staffing Data Daily postings, incorrectly identified the required components of the posting, and acknowledged that no one was currently responsible for weekend postings. The surveyor noted the absence of postings on specific dates and the lack of any record of staffing data postings for the past 18 months.
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