|§483.35(a) Sufficient Staff. |
The facility must have sufficient nursing staff with the appropriate competencies and skills sets to provide nursing and related services to assure resident safety and attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care and considering the number, acuity and diagnoses of the facility's resident population in accordance with the facility assessment required at §483.70(e).
§483.35(a)(1) The facility must provide services by sufficient numbers of each of the following types of personnel on a 24-hour basis to provide nursing care to all residents in accordance with resident care plans:
(i) Except when waived under paragraph (e) of this section, licensed nurses; and
(ii) Other nursing personnel, including but not limited to nurse aides.
§483.35(a)(2) Except when waived under paragraph (e) of this section, the facility must designate a licensed nurse to serve as a charge nurse on each tour of duty.
Based on a review of facility documentation and resident interview, it was determined that the facility failed to provide sufficient nursing staff to promote the physical and mental well-being and meet the needs of one of one resident reviewed (Resident #132).
Review of Resident #132's diagnosis list revealed diagnoses of Quadriplegia (Paralysis of all four extremities, including the trunk), injury of the cervical spinal cord, Stage four right hip pressure ulcer (ulcer involving loss of skin layers, exposing muscle and bone).
Review of Resident #132's Minimum Data Set (MDS- An assessment tool used to facilitate the management of care) dated September 23, 2019, revealed that Resident #132 was cognitively intact. Further review of the same MDS revealed that Resident R1 required extensive with two-person assistance in toileting.
Interview with Resident #132 on October 1, 2019, at approximately 11:00 a.m., revealed that on August 9, 2019, on the three to eleven shift, Resident #132 had a bowel movement in bed, Resident #132 called for help by pressing the call bell. Resident #132 stated that she/he waited for a long time, "almost two hours" but nobody showed up. The resident further stated that she/he called her/his son. Resident #132's son called the facility to inform them that Resident #132 was calling for help to get changed. Resident #132 stated that a nurse aide and a nurse showed up in her/his room and was changed. Resident #132 stated that there were other times that she/he had to wait for a long time to get changed and it usually happened during the evening shift.
Review of the facility documentation revealed a witness statement from the Assistant Director of Nursing (ADON) dated August 9, 2019, which stated "At about 10:20 p.m., I was informed by a nurse assistant that Resident #132 was ringing since 9:00 p.m., myself and the nurse assistant went in immediately to assist the resident".
The above was discussed with the Nursing Home Administrator (NHA).
The facility failed to provide sufficient staff with regard to meeting Resident #132 incontinence needs.
28 Pa Code 211.12 (a) Nursing services
28 Pa Code 211.12 (c) Nursing services
Previously cited 7/2/19, 8/8/19
28 Pa Code 211.12 (d)(3)Nursing services
Previously cited 2/5/19, 8/8/19
28 Pa Code 211.12 (d)(1)(5) Nursing services
Previously cited 2/5/19, 4/25/19, 7/2/19,8/8/19
| ||Plan of Correction - To be completed: 10/21/2019|
1. Social services followed up with affected resident and a psychosocial note or statement was completed. Grievance process was started on 8/9/19 for this concern, no negative impacts on resident skin condition.
2. An audit will be completed of grievance logs for the last 14 days to determine if any resident expressed concerns related to incontinence care and determine if it was addressed adequately.
3. Staff Development Director or designee will provide re-education to facility nursing staff that incontinence care needs to be provided in a reasonable manner to acknowledge the resident needs. This education will be completed prior to the completion of nursing staff next scheduled shift.
4. Facility leadership team will complete random interviews of residents with Brief Interview Mental Status scores of 10 or higher 3 times a week for 4 weeks then monthly to ensure incontinence care is being provided in a reasonable timeframe. Executive Director or Designee will audit grievance log weekly for 4 weeks then monthly for 2 months to review any grievance related to incontinence care and if concern was related to staffing levels.
5. A Quality Assurance/Performance Improvement plan will be developed and utilized to monitor for dignified care being provided to the residents.
Findings of the audits will be reported to the facility Quality Assurance Performance Improvement committee to determine need for additional actions and or monitoring.