| 53 |
GUARDIAN ELDER CARE AT WHEELING |
515002 |
20 HOMESTEAD AVENUE |
WHEELING |
WV |
26003 |
2018-05-03 |
725 |
E |
1 |
1 |
X20F11 |
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** > Based on observation, interview and record review the facility failed to ensure an adequate number of nurses and certified nursing assistants (CNAs) were present on a regular basis to provide care and supervision to residents. This resulted in extended call light response times, delays in meal delivery and assistance with eating, failure to follow care plans with regards to swallowing precautions, and extended periods of time where no staff were available on a unit. This failed practice had the potential to affect more than a limited number of residents. Facility census: 142. Findings included: a) Resident Council Review of Resident Council meeting minutes revealed residents voiced concern about staffing at the 3/6/18 meeting. Specifically, Extended call light response time was voiced. A resident discussed having had to wait 1.5 hours for her call light to be answered. (She needed a bed pan). The identified action was that the facility will reinforce to all staff that all employees are responsible for answering all call light. Additionally, residents voiced a concern regarding the Shortage of qualified nursing staff. The facility noted they would be offering another CNA class within the following months and that volunteers are continuously being sought. In addition, Coverage for extensive call-offs was voiced. Administration identified benefits being offered in an attempt to hire new staff. In a Resident Council meeting held as part of the survey process on 5/1/18 at 11:00 AM, residents voiced ongoing concerns about staffing. One resident stated her roommate recently waited an hour to be put to bed. She stated the staff working are very good, there just are not enough staff to meet needs timely. Resident #21 stated on night shift, she frequently waited 45 minutes to be placed on the bed pan and then another 45 minutes to be taken off the bedpan. Several other residents at the meeting reported waiting to be gotten out of bed in the morning, or put into bed at night. They stated the issue seemed to be with staff availability. Weekends were reported to be the worst. Residents stated they have complained about the staffing issue, individually and through Resident Council and they feel the only response they get is what the facility is trying to do to hire new staff. The residents stated they did not get answers as to what would be implemented to ensure they get the care they need now. b) Observations Observation on 4/30/18 at 1:18 PM revealed Resident #58 in bed. Her lunch tray was on her bedside table, covered. The meal has not been set up, nor has the resident been assisted. At 1:28 PM CNA #110 entered the room and began to feed the resident. After a minute, she left the room to get some ice water for the resident, returned and began feeding her again. At 1:35 PM, she told the resident she had to go check on some people and will be back. She returned at 1:43 PM and again began to feed her. There were no other staff observed on the unit at this time. Observations on 5/2/18 revealed two residents (#s 91 & 8) using/possessing straws that had physician's orders [REDACTED]. This occurred on Unit 5, where the nurse's and CNAs frequently float, meaning there were extended periods of time with no nurse and only one CNA providing care / supervising up to 22 residents. See F689. Observation on 5/2/18 at 6:36 AM revealed the call light for room [ROOM NUMBER] sounding. At 6:40 AM, the call lights for 706 and 711 were sounding. No staff were observed on either the 600 or 700 hall. At 6:42 AM, a CNA was observed exiting a resident room on the 600 unit and entering room [ROOM NUMBER]. She stated she was covering both units and had been in a resident room on the 600 unit, so had not heard the call lights on the 700 unit. Observation on 5/3/18 at 12:23 PM on Unit 5 revealed two call lights sounding (rooms [ROOM NUMBERS]). There were no staff visible. Resident #8 was sitting by the nurse's station. He stated, I just want a drink of water. There's no one here. Been here awhile, no one to help. A lunch tray for Resident #107 was sitting on the nurse's station. The resident in room [ROOM NUMBER] called out nurse several times. At 12:38 PM, CNA #105 exited a resident room, where the door had been closed. She stated she had been providing personal care and was the Only staff here right now. c) Interviews In interviews on 5/2/18 on night, day and evening shift, as well as day shift on 5/3/18, CNAs and nurses, who all expressed concern about repercussions if their names were used and spoke on the condition of confidentiality, stated they worked short frequently and float on units, meaning they are not always available to provide timely care. They expressed a great deal of concern about the safety and care of their residents. They stated the facility was trying to hire new staff and day and evening shifts during the week were well covered, but night shift and weekends, especially when staff called in, were the concerning ones. In an interview on 5/2/18 at 6:24 AM, a CNA who worked the night shift explained she frequently was assigned to cover two units. She stated the units were physically separated and so she did not know if a call light was going off or a resident needed help on one unit while she was on the other. She stated she was very concerned about her ability to protect residents and provide timely care. She stated she had expressed this concern to her supervisor, but she was told that was the staffing pattern. She stated there was often only one nurse on the floor, for 4 units, which made it difficult if more than one resident needed nursing care. In an interview on 5/2/18 at 6:52 AM, a CNA who worked the night shift stated she did not feel comfortable when asked to cover two units, as she did not feel she could provide good care to everyone on two units. She stated she could not see or hear call lights for the second unit when you were on the first. You don't know if someone fell , you don't know how long they have been waiting. She explained there was frequently only one nurse on the floor, for four units and if someone fell or was sick, the nurse would be occupied for an extended period of time making it difficult for other residents to receive nursing care. On 5/2/18 there were 2 CNAs on Unit 5 for the evening shift. At 4:39 PM, a phone call to the Unit notified them one of the CNAs on Unit 5 would be pulled to Unit 3 at 7:00 PM. The CNAs, speaking to each other, stated they would have to put residents in bed before supper, as many of them require 2 staff to do so and there would only be one staff member after 7:00 PM. They stated one CNA would not have time or be able to put all the residents to bed by herself. In an interview on 5/3/18 at 8:49 AM the Assistant Director of Nursing #88, stated she is in charge of scheduling. She explained the facility has 7 units. 2 have a maximum of 20 residents, the other 5 have 22 beds. The facility attempts to schedule one CNA to 10-11 residents (2 CNAs per unit) on day and evening shifts. ADON #88 stated with call-ins, they are sometimes closer to one CNA with 15 residents. On the night shift, they attempt to schedule one CNA per unit. ADON #88 stated she knows staff frequently have to float between units, due to a lack of available staff. On 5/3/18 at 8:20 AM the Daily Staffing Postings for the past 3 months were reviewed. They revealed numerous shifts in which only 5 CNAs were scheduled, when the facility had a census of between 141-145. This gave each CNA up to 28 residents each, much higher than the one to 15 the ADON stated the facility felt comfortable with. For example, on 2/11/18, the night shift (for a census of 144), had 4 nurses and 5 CNAs. On night shift Friday, 3/2/18, 5 CNAs and 2 nurses were scheduled. On night shift Monday, 4/9/18, for a census of 147, 5 CNAs and 4 nurses were scheduled. On the night shift Sunday, 4/15/18, 5 CNAs and 3 nurses were scheduled; night shift Saturday 4/21/18 had 6 CNAs and 3 nurses. In an interview on 5/3/18 at 8:57 AM, the Administrator explained the facility has implemented numerous strategies to attempt to recruit and retain employees. She acknowledged it was an ongoing struggle due to a lack of certified staff and numerous other employers in the area. She acknowledged residents complained about the lack of staff at a recent Resident Council meeting. She stated she was not aware staff were telling residents they were unable to take breaks or that they were working short. She stated staff should not be telling residents this. |
2020-09-01 |