Posted nurse staffing information was missing required details, including the facility census, the total hours worked per discipline per shift, and the total hours worked for each shift. Observation of the posted staffing sheets and review of 30 days of documentation showed the same omissions, and the DON confirmed that the census and hour calculations were not included or documented.
The facility did not complete or display the required daily nurse staffing postings for a census of 75 residents, despite a policy requiring posting of the facility name, date, census, and total number and hours worked by nursing staff at the start of each shift. During a walk-through, surveyors observed that no daily nurse staffing information was posted, and the DON confirmed it was missing and should have been present, with only 1 nurse scheduled for days and 1 for nights. The RNC reported that daily staffing postings had not been done for about two weeks due to turnover in the scheduler position, and the new Scheduling Coordinator stated they were unaware that completing and posting daily nurse staffing information was part of their responsibilities.
Posted nurse staffing sheets were missing required information. The facility's policy stated the sheet would include the facility name and the total number and actual hours worked by RNs, LNs, and NAs each shift, but posted PPD Calculator staffing sheets did not show the facility name or each shift's staffing numbers or hours worked. The Administrator and Staffing Coordinator both confirmed the omissions.
Staffing information was not posted as required. Surveyors observed no staffing sheet in the hallways, nurses' station, lobby, entrance, or front office areas, and a whiteboard near the nurses' station only listed staff names without hours or census information. An LPN and the ADM confirmed there was no written staffing sheet posted and that the facility used the whiteboard to list scheduled staff.
The facility failed to ensure the daily nursing staff posting included the resident census. Review of the staffing forms showed the census was not documented, and the DON confirmed the posting did not contain the required census information.
Failure to post complete daily staffing information: the facility’s Daily Staffing Logs did not show the total number of hours worked by discipline or by shift for staff directly responsible for resident care. The RN confirmed the log was updated by the night shift only, and the ADON confirmed there was no Daily Staff Posting policy and that the logs did not separate staff by discipline or include total hours worked by shift.
Daily nursing staff postings were missing required information. Surveyors observed the Nursing Staff Information form at the front desk without the date or census, and record review showed the form listed facility name, shift hours, team members, and total staffing hours but not the required date or census. The SDN confirmed the postings provided to surveyors were undated and did not include the census.
Inaccurate Posting of Nursing Staff Hours: The facility failed to ensure the daily posted nursing staff hours were accurate. Record review showed the posted RN and LPN hours did not match the nursing schedule for reviewed shifts, and the DON and Administrator confirmed the professional nursing hours included staff working in the ALF and were not removed from the posted nursing staff hours.
Posted nurse staffing information did not include the required total actual hours worked per discipline. Review of 30 days of staffing postings showed the daily records lacked the total hours worked for the different staff types, and the Administrator confirmed the hours had not been calculated or documented on the postings.
The facility did not ensure that the posted Daily Nurse Staffing Form accurately reflected the actual census, as the form consistently displayed a higher number than the true census confirmed by administrative staff. Staff interviews revealed a lack of policy and procedure for completing the form, and the form was not updated daily as required.
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