AHWATUKEE POST ACUTE

§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.

Based on staff interviews, staffing documentation and facility assessment, policy and procedure, the facility failed to ensure adequate staffing was maintained to meet the needs of the residents. The deficient practice could result in necessary services not provided to residents. Findings include: The Facility Assessment reviewed on August 31, 2021 revealed the average daily census was 100 (78 for long-term care and 22 for skilled nursing). The assessment included that the residents who were dependent upon staff for activities of daily living (ADLs), including dressing, bathing, transfer, eating and toileting ranged from 18-27; residents who required assistance of one to two staff for ADLs ranged 61-77; and, residents who were independent ranged from 2-21. According to the assessment, the daily staffing necessary to meet the needs of the residents at any given time included: the registered nurse (RN) was typically at 0.24 hours allotted per day/per resident (PPD), licensed practical nurse (LPN) was typically at 0.95 PPD and certified nursing assistant (CNA) was typically around a 1.80 PPD - 1.95 PPD. The average daily census in December 2022 was 101. However, review of the December 2022 staffing documentation included the following information: -RN was less than 0.24 PPD on more than 10 dates; -LPN was less than 0.95 PPD on 5 or more dates; and, -CNA was less than 1.80 PPD on more than 12 dates. In February 2023, the average daily census was 102. However, the February 2023 staffing documentation revealed that the RN was less than 0.24 PPD on 8 or more dates; and, the CNA was less than 1.80 PPD on 8 or more dates. During a phone interview conducted a CNA (staff #78) on June 15, 2023 at 8:34 a.m., the CNA stated that on a good night, there will be 5 nurses and 5 CNAs. She stated that she works overtime (4 - 12-hour shifts) to help pick up the slack. However, she stated that at least one or two nights per week there will be 3 aides. A phone interview with the staffing coordinator/unit manager (staff #88) was conducted on June 15, 2023 at 11:51 a.m. Staff #88 stated that she had been doing staffing since March 2023. She stated the facility was staffed by 2 - 12-hour shifts; and that, depending on the census, she would staff 6-8 CNAs on day shift and 5-6 CNAs on evenings/nights. Staff #88 said that if the census was 110 or higher she would add another CNA. She stated she needed 5 nurses for day shift, and 4 or 5 nurses for nights. She also said that she always staffs an RN for 8 consecutive hours per day, 7 days per week. Regarding the staff on December 2022 and February 2023, staff #88 stated that she could not specifically address this; and that, she did work in the facility during that time, but did not really remember whether inadequate staffing had occurred. An interview was conducted on June 15, 2023 at 12:13 p.m. with the Director of Nursing (DON/staff #82) who stated that her understanding was that the staffing levels met the requirements as laid out in the Facility Assessment; and that, the facility had always met the staffing criteria. The DON said that the consequences of inadequate staffing would include less time spent on care and resident quality of life might be postponed i.e., the resident may not be able to smoke when they would like, or they may not be able to have a 3rd shower per week. The facility policy on Staffing/Center Plan included that the facility will provide qualified and appropriate staffing levels to meet the needs of the resident population. The staffing plan will include all shifts, seven days per week to assure that appropriate staffing levels are scheduled and maintained. The facility maintains appropriate staffing levels, with qualified personnel, 24 hours/day, seven days/week on each shift to assure that residents are safe and their needs are met.

Based on staff interviews, staffing documentation and facility assessment, policy and procedure, the facility failed to ensure adequate staffing was maintained to meet the needs of the residents. Findings include: The Facility Assessment reviewed on August 31, 2021 revealed the average daily census was 100 (78 for long-term care and 22 for skilled nursing). The assessment included that the residents who were dependent upon staff for activities of daily living (ADLs), including dressing, bathing, transfer, eating and toileting ranged from 18-27; residents who required assistance of one to two staff for ADLs ranged 61-77; and, residents who were independent ranged from 2-21. According to the assessment, the daily staffing necessary to meet the needs of the residents at any given time included: the registered nurse (RN) was typically at 0.24 hours allotted per day/per resident (PPD), licensed practical nurse (LPN) was typically at 0.95 PPD and certified nursing assistant (CNA) was typically around a 1.80 PPD - 1.95 PPD. The average daily census in December 2022 was 101. However, review of the December 2022 staffing documentation included the following information: -RN was less than 0.24 PPD on more than 10 dates; -LPN was less than 0.95 PPD on 5 or more dates; and, -CNA was less than 1.80 PPD on more than 12 dates. In February 2023, the average daily census was 102. However, the February 2023 staffing documentation revealed that the RN was less than 0.24 PPD on 8 or more dates; and, the CNA was less than 1.80 PPD on 8 or more dates. During a phone interview conducted a CNA (staff #78) on June 15, 2023 at 8:34 a.m., the CNA stated that on a good night, there will be 5 nurses and 5 CNAs. She stated that she works overtime (4 - 12-hour shifts) to help pick up the slack. However, she stated that at least one or two nights per week there will be 3 aides. A phone interview with the staffing coordinator/unit manager (staff #88) was conducted on June 15, 2023 at 11:51 a.m. Staff #88 stated that she had been doing staffing since March 2023. She stated the facility was staffed by 2 - 12-hour shifts; and that, depending on the census, she would staff 6-8 CNAs on day shift and 5-6 CNAs on evenings/nights. Staff #88 said that if the census was 110 or higher she would add another CNA. She stated she needed 5 nurses for day shift, and 4 or 5 nurses for nights. She also said that she always staffs an RN for 8 consecutive hours per day, 7 days per week. Regarding the staff on December 2022 and February 2023, staff #88 stated that she could not specifically address this; and that, she did work in the facility during that time, but did not really remember whether inadequate staffing had occurred. An interview was conducted on June 15, 2023 at 12:13 p.m. with the Director of Nursing (DON/staff #82) who stated that her understanding was that the staffing levels met the requirements as laid out in the Facility Assessment; and that, the facility had always met the staffing criteria. The DON said that the consequences of inadequate staffing would include less time spent on care and resident quality of life might be postponed i.e., the resident may not be able to smoke when they would like, or they may not be able to have a 3rd shower per week. The facility policy on Staffing/Center Plan included that the facility will provide qualified and appropriate staffing levels to meet the needs of the resident population. The staffing plan will include all shifts, seven days per week to assure that appropriate staffing levels are scheduled and maintained. The facility maintains appropriate staffing levels, with qualified personnel, 24 hours/day, seven days/week on each shift to assure that residents are safe and their needs are met.