§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.
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Observations:
Based on review of facility policy and resident interviews and observations, it was determined that the facility failed to ensure sufficient staffing to meet resident need for ten of twelve residents (Resident R1. R2, R3, R4, R5, R6, R7, R8, R9, and R10).
Findings include:
Review of the facility policy, "Staffing" dated 3/28/23, indicated the facility will provide adequate staffing to meet needed care and services for our resident population.
During an interview on 7/18/24, at 10:54 a.m. Resident R1, when asked if she felt the facility had sufficient staff stated, "No, they work too hard."
During an interview and observation on 7/18/24, at 10:57 a.m. when asked if she felt the facility had sufficient staff stated, "Nope." When asked if she received sufficient bathing, Resident R2 stated, "This past week I got one. I only got one this week because they said they were short." When asked about call light response time, Resident R2 stated, "There many times I've waited over an hour."
During an observation on 7/18/24, at 11:02 a.m. a call light was heard to be alarming. State Agency asked Licensed Practical Nurse (LPN) Employee E1 where the call lights alarm. LPN Employee E1 displayed the panel on the wall, which revealed Resident R3's room alarming. LPN Employee E1 then returned to the nurses' station, where she and an additional staff member were seated. Neither staff member responded to Resident R3's call light.
During an interview and observation on 7/18/24, at 11:06 a.m. Resident R4 was noted to have unkempt hair and facial hair. When asked if he preferred the beard, Resident R4 responded, "I need a shave and a haircut too. It's been a while."
During an interview on 7/18/24, at 11:09 a.m. Resident R5, when asked if he felt the facility had sufficient staff stated, "No." When asked what she would like to see, if the facility had more staff, Resident R5 stated, "Be able to spend more time on care. Don't get me wrong, the care is good, but rushed."
During an interview on 7/18/24, at 11:15 a.m. Resident R6, when asked if he felt the facility had sufficient staff stated, "They are short-handed. I feel bad for the girls, running around like chickens with their heads cut off." When asked about call light response, Resident R6 confirmed that it can be "a little long."
During an interview on 7/18/24, at 11:20 a.m. Resident R7, when asked if she felt the facility had sufficient staff stated, "The girls are overworked."
During an observation on 7/18/24, at 11:22 a.m. Resident R8 when asked if she felt the facility had sufficient staff stated, "Sometimes there's not enough to care for the residents." Resident R8 was observed at this time as having facial hair that she was not assisted to remove.
During an interview on 7/18/24, at 11:30 a.m. Resident R9, when asked if they felt the facility had sufficient staff stated, "There could be more, I think."
During an interview on 7/18/24, at 11:36 a.m. Resident R10, when asked about call light response stated, "I put the light on, nobody comes. I'm waiting, waiting. I have to push the button again. That's not right."
Review of two months of Resident Council minutes (May and June 2024) revealed that call light response was a concern in May 2024.
During an interview on 7/18/24, at approximately 1:00 p.m. the Nursing Home Administrator and the Director of Nursing confirmed that the facility failed to ensure sufficient staffing to meet resident need for ten of twelve residents.
28 Pa. Code 201.14(a) Responsibility of licensee.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
| | Plan of Correction - To be completed: 08/15/2024
Residents that were identified have received ADL care to include bathing/showers, shaving and grooming per care plan. Whole house audit completed of residents needing shaved and haircuts. Residents needing shaved were provided care by CNA and list of haircuts needed given to hairdresser to be completed when in facility. Care plans completed for residents who prefer to have facial hair.
Staffing is reviewed daily to ensure adequate staffing numbers. Scheduler alerts administration of staff shortage at time of occurrence. Facility will contract with agency to assist with proper staffing of nursing staff. If additional staff are needed or facility receives call offs, calls will be made to agency and facility staff to attempt to cover needs. Facility currently offering bonuses to in house staff. Facility is paired with outside agencies such as career link and local technical schools. Facility will be holding CNA class. Facility regularly updates postings on job board websites. Facility held open interviews "Lunch and Interview" on 7/11/24.
DON/Designee will do education with all nursing staff on Bed Bath/Showers, Brushing and Combing Hair, Shaving the Resident and with all staff on Answering the Call Light. Education to nurse aides to alert /report to nursing supervisor when care is not able to be provided and on proper documentation of care not provided.
DON/Designee will audit 2x weekly for 4 weeks of call lights on all shifts, 4 residents per audit, and showers/bathing including grooming and facial hair removal 4 residents per audit.
Results of audit to be reported to QAPI committee.
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