§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 nursing unit observations, resident observations, and resident and staff interviews, 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 18 of 23 residents (Resident R1, R2, R3, R4, R5, R6, R7, R8, R9, R10, R11, R12, R13, R14, R15, R16, R17, and R18).
Findings include:
During an interview on 3/8/24, at 9:50 a.m., when asked if there were enough nursing staff to care for the residents Resident R1 stated, "I have to wait forever and ever for an aide. They gather out in the halls and they ignore the call lights. Sometimes I'm wet from 8:30 on. They just lolly-gag." "I don't get no showers, are you kidding? I get a bed bath, swish swish." "I'm just here." When asked about call light response, Resident R1 stated, "I have to lay on the light, and I mean lay on the light." "They don't answer. We have to holler."
During an interview and observation on 3/8/24, at 10:00 a.m., when asked if there were enough nursing staff to care for the residents Resident R2 stated, "No." When asked about call light response, Resident R2 stated, "It takes a long time." When asked about staff not providing care, Resident R2 stated, "We see it everyday."
During the interview completed with Resident R1 and Resident R2, the room across the hall was observed (Resident R3 and Resident R4) to have the light above the door illuminated, and the audible call light sound was able to be heard. Social Services Employee E1 interrupted the above interviews to enquire if the surveyor needed assistance, but did not respond to the alarming call light at 9:57 a.m., or again when she passed the room at 10:04 a.m. Licensed Practical Nurse (LPN) Employee E2 (while training another staff member) passed the alarming room at 9:59 a.m., and again at 10:05 a.m. without providing assistance either time. Registered Nurse (RN) Supervisor Employee E3 passed the room without providing assistance at 10:03 a.m. RN Supervisor did answer the call for assistance at 10:05 a.m.
During an interview on 3/8/24, at 10:07 a.m., when asked if there were enough nursing staff to care for the residents, Resident R5 stated, "No." When asked about call light response, Resident R5 stated, "I've waited 45 minutes." Resident R5 further confirmed that she has been told she needs to wait when she has asked for assistance.
During an interview on 3/8/24, at 10:10 a.m., when asked if call light response was long, Resident R6 stated, "Oh, yeah. Nobody comes."
During an interview on 3/8/24, at 10:16 a.m., when asked if there were enough nursing staff to care for the residents, Resident R7 stated, "No, big time no. They have to work their poor little bums off."
During an interview on 3/8/24, at 11:40 a.m., Resident R8 stated that sometimes she receives her medications late.
During an observation on 3/8/24, at 11:43. am. Resident R9 was noted to have greasy-appearing, unkempt hair and long fingernails with a brown substance under the nails.
During an observation on 3/8/24, at 11:44 a.m., Resident R10 was noted to be laying in bed, with no top sheet or blanket available to him, positioned in the bed with his feet against the foot board and having to bend his legs, and the bottom sheet on the bed had what appeared to be feces on it.
During an interview and observation on 3/8/24, at 11:51 a.m. when asked about call light response, Resident R11 stated, "It depends on the day." Resident R11 was noted to have greasy-appearing hair.
During an interview on 3/8/24, at 11:55 a.m. when asked if there were enough nursing staff to care for the residents, Resident R12 stated, 'No. No way."
During an observation on 3/8/24, at 11:58 a.m., Resident R13 was noted to have unkempt hair.
During a group staff interview completed with Nurse Aides (NA) Employees E3, E4, and E5, when asked about staffing the following was stated:
NA Employee E3, "They definitely could use more staff."
NA Employee E4, "This is a heavy hall, and we could use more."
NA Employee E5, "It's not worth it for me. I'm leaving. They need more staff."
This interview was completed in approximately 2-3 minutes.
During the above group staff interview completed at the nurse's station, NAs Employee E3 and E4 were eating salad, and NA Employee E5 was seated. While interviewing staff, the call light monitor was observed:
Resident R6's call light had been alarming for 19:04 minutes.
Resident R18's call light had been alarming for 17:24 minutes.
Resident R5's call light had been alarming for 12:47 minutes.
Resident R7's call light had been alarming for 9:13 minutes.
During an observation on 3/8/24, at 12:10 p.m., Resident R14 was noted to be unshaven and have unkempt hair.
During an interview on 3/8/24, at 12:12 p.m. when asked if there were enough nursing staff to care for the residents, Resident R15 stated, "No." When asked about call light response, Resident R15 stated, "It takes a long time for call lights."
During an interview on 3/8/24, at 12:15 p.m., Resident R16 stated that she receives her medications at a different time every day. When asked about call light response, Resident R16 stated, "They turn off the light and say, I'll be back, I'll be back."
During an interview on 3/8/24, at 12:20 pm., when asked if there were enough nursing staff to care for the residents, Resident R17 stated, "No." When asked about call light response, Resident R17 stated, "Sometimes it's 15 minutes, sometimes it's an hour and a half. Then they just walk by." When asked if she has ever been left for a lengthy time in a soiled brief, Resident R17 stated, "I had a wet diaper on for six and half hours on one time, and eight hours another." When asked if she receives her medications on time, Resident R17 stated, "It depends on the nurses."
During an interview on 3/8/24, at 1:00 p.m. the Nursing Home Administrator confirmed that the facility failed to have sufficient nursing staff to provide nursing and related services to 18 of 23 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: 03/27/2024
Rounds were completed to ensure all active call bells were responded to. An audit of all residents was conducted to ensure personal hygiene needs were met. To ensure residents needs are being met concierge rounds are being conducted by department managers and nursing staff to confirm resident care issues are being addressed in a timely manner. During concierge rounds, call bell response audits and resident interviews will be conducted to monitor improvement.
To prevent recurrence, Nursing staff will be reeducated by DON/Designee on resident care needs (ie., proper clothing, showers, hair washing, assistance with meals, call bell response, and medication administration). Current center staff will be reeducated on call bell response by the NHA/ designee.
To monitor and maintain compliance, Audits will be conducted by the Director of Nursing/ designee 3x weekly x4 weeks, 1x week x4 weeks 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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