§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 facility documents, resident observations, resident and staff interviews, and grievance review, it was determined that the facility failed to have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of 16 of 25 residents (Resident R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, and R16).
Findings Include:
Review of the "Facility Assessment" dated 1/2/24, indicated the facility will provide necessary person-centered care and services.
During an observation on 2/17/24, at 12:13 p.m., Resident R1 had unkempt, greasy appearing hair. Resident R1 was eating lunch, still wearing a gown.
During an interview and observation on 2/17/24, at 12:16 p.m., when asked if there were enough nursing staff to care for the residents, Resident R2 stated that she had no concerns. Observation at this time revealed Resident R2 to be still wearing a gown while eating lunch, slumped to her left side, leaning against her enabler bar. Resident R2's meal cover was still on her food, and she appeared to be struggling to open her food containers.
During an observation on 2/17/24, at 12:18 p.m., Resident R3 was wearing a brief with a gown only around her neck, hanging off the side of the bed.
During an interview on 2/17/24, at 12:21 p.m., Resident R4 was observed with her tray on the overbed table, not being assisted to eat. Review of this residents Minimum Data Set (MDS - periodic assessment of resident care needs) dated 12/20/23, indicated Resident R4 is dependent on staff for eating assistance.
During an observation on 2/17/24, at 12:24 p.m., Resident R5 was observed to be eating lunch in a gown.
During an observation on 2/17/24, at 1:15 p.m., Resident R6 and Resident R7 were observed in their room, both in gowns, eating lunch.
During an observation on 2/17/24, at 1:16 p.m., Resident R8 was observed with unkempt hair.
During an interview on 2/17/24, at 1:18 p.m., when asked if there were enough nursing staff to care for the residents, Resident R9 stated, "No, not enough aides." Resident R9 stated her biggest concern with the facility was "not having enough people."
During an interview on 2/17/24, at 1:26 p.m., when asked if there were enough nursing staff to care for the residents Resident R10 stated, "There isn't enough of them. Sometimes they put my pills on the table and leave." "They try to avoid work. I would never send anyone here."
During a group interview of Resident R11, Resident R12, and Resident R13 on 2/17/24, at 1:30 p.m., when asked if there were enough nursing staff to care for the residents, Resident R11 stated, "There aren't enough here." Resident R12 stated, "There isn't. It always takes a long time (in reference to call light response). There isn't enough." Resident R13 stated "These poor girls who work here." When asked about showers, Resident R13 stated, "It depends on how much help there is. I would love to have my hair washed more often."
Confidential staff interviews conducted during the survey about sufficient facility staffing indicated the following:
Employee E1 stated, "Staffing is always a problem. They bring in people to have them "in the building" (staff member utilized finger quotations), but they actually don't help."
Employee E2 stated, "I have more than the state ratio today."
Employee E3 stated, "For me, it's the mandations. I don't want mandated."
Employee E4 stated, "It's bad." We have to share nurses and nurse aides with the MIU (Memory-impaired unit). Sometimes the MIU only has one aide, and no nurse if she's passing meds on another hall. It's not safe to have 19 residents with dementia and only one person."
Employee E5 stated, "Staff don't show up. We have to call the DON (Director of Nursing) to ask if the on-call nurse can be called in. But they don't always bring them in. We get told, "It is what it is.""
A review of grievances from January 2024, through February 2024, revealed the following:
1/19/24: Resident R14 "reported that he sat in his own urine for four hours on 1/18/24. Resident stated that he yelled out for staff and had the call bell on. Resident reported that he was unable to get staff for 2.5 hours."
1/29/24: Resident R15 "stated he was left in a soiled brief (exact dates unknown) with a delayed response to his call bell light.
1/30/24: Family member for Resident R16 "reported that on 1/29/24, her father was already out of bed and did not receive morning care." "Staff need to provide him with a drink throughout the day."
During an interview on 2/17/24, at 3:15 p.m. the Director of Nursing was made aware that the facility failed to have sufficient nursing staff to provide nursing and related services to 16 of 25 residents.
28 Pa. Code: 201.14(a) Responsibility of licensee.
28 Pa. Code: 201.18(e)(6) Management.
28 Pa. Code: 201.20(a) Staff development.
28 Pa. Code: 211.12(a) (c)(d)(1)(2)(3)(4)(5) Nursing services.
| | Plan of Correction - To be completed: 03/11/2024
Preparation and submission does not constitute an admission of agreement by the provider of the truth of the facts alleged or the correctness set forth in the statement of deficiencies. The plan of correction is prepared and submitted soley because of requirements under the state and federal laws.
Resident 1 no longer resides in the facility.
R2 prefers to wear a gown. R2 will be monitored by nursing and concierge rounds for proper positioning and assistance at meals.
R3 will be monitored by nursing and concierge rounds to ensure proper positioning in bed.
R4 will be monitored by nursing supervisor to assure staff is assisting with meals.
R5 was interviewed and stated to the Director of Nursing that she prefers to wear a hospital gown.
R6 and R7 were interviewed by the Director of Nursing regarding their preference to be up and dressed for lunch. During concierge rounds residents will be monitored for compliance.
R8 no longer resides at the facility.
R9 was interviewed by the Director of Nursing and assured facility is adequately staffed. R9 will be interviewed on concierge rounds to ensure needs are being met.
R10 was interviewed by the Director of Nursing and assured that medication administration policy was reviewed with nursing staff.
R11 was interviewed by the Director of Nursing and reassured facility is adequately staffed. R11 will be interviewed on concierge rounds to ensure her needs are being met.
R12 was interviewed by the Director of Nursing regarding call light response. R12 will be interviewed during concierge rounds to ensure call light is answered in a timely manner.
R13 was interviewed by the Director of Nursing about her hair being washed. R13 is on the schedule to have her hair washed 2x week.
R14 no longer resides at the facility.
R15 was interviewed by the Director of Nursing regarding call light response. R15 will be interviewed during concierge rounds to ensure call light is answered in a timely manner.
R16 no longer resides at the facility.
To prevent recurrence, nursing staff will be educated by Staff Development/Designee on resident care needs (ie., proper clothing, showers, hair washing, assistance with meals, call bell response, and medication administration).
To monitor and maintain compliance, audits will be conducted by the Director of Nursing/Designee, 5x weekly x4 weeks,
1x week x4weeks then monthly x2 to ensure resident care needs are being met.
Results of the audits will be forwarded to the center QAPI committee for review and recommendation.
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