(2) Effective July 1, 2023, a minimum of 1 nurse aide per 12 residents during the day, 1 nurse aide per 12 residents during the evening, and 1 nurse aide per 20 residents overnight.
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Observations:
Based on review of nursing time schedules and staff interview it was determined that the facility failed to provide a minimum of one nurse aide per 10 residents during the dayshift on 19 of 21 days (7/25, 7/26. 7/27, 7/28, 7/29, 7/30, 7/31, 8/1, 8/2, 8/3, 8/4, 8/5, 8/6, 8/7, 8/8, 8/10, 8/12, 8/13, and 8/14/24), failed to provide one nurse aide per 11 residents during the evening shift on 18 of 21 days (7/25, 7/26, 7/28, 7/29, 7/30, 7/31, 8/1, 8/3, 8/4, 8/5, 8/7, 8/8, 8/9, 8/10, 8/11, 8/12, 8/13, and 8/14/24), and failed to provide a minimum of one nurse aide per 15 residents on the night shift on 21 of 21 days (7/25/24 through 8/8/24).
Findings include:
Review of the facility census data, nursing time schedules, and deployment sheets from 7/25/24 through 8/14/24, revealed the following nurse aide staffing shortages:
On 7/25/24 through 7/27/24, the census was 70, which required 7.00 NAs during the day shift. Review of the nursing time schedules revealed 6.84, 6.00, and 6.97 NAs provided care on the day shift. No additional excess higher-level staff were available to compensate this deficiency.
On 7/28 through 8/1/24, the census was 69, which required 6.90 NAs during the day shift. Review of the nursing time schedules revealed 6.00, 6.00, 5.00, 6.00, and 5.88 NAs provided care on the day shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/2, 8/3, and 8/4/24, the census was 70, which required 7.00 NAs during the day shift. Review of the nursing time schedules revealed 5.03, 6.00, and 6.00 NAs provided care on the day shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/5, 8/6, 8/7, and 8/824, the census was 72, which required 7.20 NAs during the day shift. Review of the nursing time schedules revealed 6.00, 6.00, 5.00, and 6.00 NAs provided care on the day shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/10, 8/12, 8/13, and 8/14/24, the census was 68, which required 6.80 NAs during the day shift. Review of the nursing time schedules revealed 6.06, 6.00, 6.00, and 6.00 NAs provided care on the day shift. No additional excess higher-level staff were available to compensate this deficiency.
On 7/25 and 7/26/24, the census was 70, which required 6.36 NAs during the evening shift. Review of the nursing time schedules revealed 6.03 and 6.09 NAs provided care on the evening shift. No additional excess higher-level staff were available to compensate this deficiency.
On 7/28, 7/29, 7/30, 7/31, and 8/1/24, the census was 69, which required 6.27 NAs during the evening shift. Review of the nursing time schedules revealed 6.00, 5.44, 5.91, 6.00, and 5.88 NAs provided care on the evening shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/3, 8/4 and 8/9/24, the census was 70, which required 6.36 NAs during the evening shift. Review of the nursing time schedules revealed 6.06, 5.53, and 4.88 NAs provided care on the evening shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/5, 8/7 and 8/8/24, the census was 72, which required 6.55 NAs during the evening shift. Review of the nursing time schedules revealed 5.50, 5.00, and 6.00 NAs provided care on the evening shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/10/24 through 8/14 24, the census was 68, which required 6.18 NAs during the evening shift. Review of the nursing time schedules revealed 5.97, 6.03, 5.50, 5.00, and 5.50 NAs provided care on the evening shift. No additional excess higher-level staff were available to compensate this deficiency.
On 7/25, 7/26, 7/27, 8/2, 8/3, 8/4, and 8/9/24, the census was 70, which required 4.67 NAs during the night shift. Review of the nursing time schedules revealed 3.50, 3.94, 4.00, 4.67, 4.67, 4.67, and 4.67 NAs provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.
On 7/28, 7/29, 7/30, 7/31, and 8/1, the census was 69, which required 4.60 NAs during the night shift. Review of the nursing time schedules revealed 4.00, 3.50, 3.97, 4.00, and 3.91 NAs provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/5, 8/6, 8/7, and 8/824, the census was 72, which required 4.80 NAs during the night shift. Review of the nursing time schedules revealed 4.00 NAs provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.
On 8/10, 8/11, 8/12, 8/13, and 8/14/24, the census was 68, which required 4.53 NAs during the night shift. Review of the nursing time schedules revealed 3.97, 3.97, 4.00, 4.00, and 4.00 NAs provided care on the night shift. No additional excess higher-level staff were available to compensate this deficiency.
During an interview on 8/14/24, at 1:30 p.m. the Nursing Home Administrator confirmed the above findings and the facility failed to provide the minimum nurse aides per residents during the day on 19 of 21 days, during the evening on 18 of 21 days, and during the night on 21 of 21 days. (July 25 through August 14, 2024).
| | Plan of Correction - To be completed: 09/27/2024
The facility was unable to make corrective action for the nurse aide ratio/PPD for identified days that have passed. All residents received care in accordance with their care plans and physician orders.
Don/designee will re-educate the labor manager and RN supervisors on the 7/1/2024 requirements.
Facility continues to offer incentives, Competitive wages and several other benefits in an effort to hire for all open positions.
Admin, DON and Labor manager will conduct daily staffing meetings Monday -Friday to review (ratios/PPD's) throughout the day, the following day, and the weekend. In the event of vacancies the facility will follow staffing policies including offering open shifts to internal, Contracted agency staff and offering current staff to stay extra or start earlier.
DON/Designee will audit daily staffing ratios and PPD along with all steps taken to fill vacancies 5 days a week and ongoing.
Results of the audits will be reviewed and recorded in the monthly QAPI meetings.
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