Insufficient Staffing Leading to Delayed Assistance With ADLs and Call Lights
Penalty
Summary
The deficiency involves the facility’s failure to provide sufficient nursing staff on each shift to meet residents’ needs, resulting in delayed care and inadequate assistance with activities of daily living (ADLs). Multiple CNAs reported being assigned large caseloads, including several residents requiring two-person assistance or use of a Hoyer lift, and stated there were not enough CNAs scheduled. CNAs described having to wait for help from other units, rushing through showers and ADL care, and leaving call lights unanswered for up to 30 minutes while they were occupied with other residents. One CNA reported that showers are done on day shift because there are not enough staff on night shift to complete them. The scheduler confirmed that only two to five CNAs are scheduled per 12-hour shift depending on availability, that there is high staff turnover, and that she often cannot find staff to cover call-ins. The administrator acknowledged staffing is a challenge, that he would like more CNAs on the floor than he is able to schedule, and that night shift typically has only two CNAs. Resident-specific findings further demonstrated the impact of staffing shortages. One resident’s care plan showed a need for setup/clean-up assistance with eating and hydration, and setup assistance with upper and lower body dressing and toilet hygiene; this resident reported that sometimes there are not enough staff and that he has to wait for assistance because staff are busy. Another resident’s MDS documented substantial/maximal assistance needs for sit-to-stand and partial/moderate assistance for toilet transfer and sit-to-lying, with supervision or touching assistance needed for lying to sitting. During an observation, this resident’s call light was on while no staff were present on the unit; the CNA had gone to lunch and the LPN and assigned CNA were occupied with wound care. By the time the scheduler responded to the call light, the resident had already transferred himself to his wheelchair, stating he did it himself after waiting. The resident and his sister reported that he had needed help to get out of bed, became tired of waiting, and that he sometimes waits 30 minutes or more for assistance and that it can be hard to find staff.
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