| 10 |
GREENBRIAR HEALTHCARE |
305005 |
55 HARRIS ROAD |
NASHUA |
NH |
3062 |
2018-03-05 |
725 |
F |
0 |
1 |
6C1411 |
Based on observation, interview (Residents, Family, Staff) and review of staffing records, the facility failed to provide adequate staffing to provide care, safety, and a healthy milieu to all residents at the facility. Findings include: During the recertification survey from 2/27 to 3/5, four members of the facility staff were asked if they had enough staffing to properly care for residents. Based on answers received from direct interviews, two of the four interviewed, Staff D Registered Nurse (RN) and Staff F (RN) replied there was not enough staff to properly care for residents. Staff [NAME] (RN) replied that adequate staffing depended on the shift, the occasion, residents, and acuity. Staff G replied that staffing was tough on the evening, nights, and weekend shifts. Resident #160. Interview on 2/17/18 at approximately 10:20 a.m. with Resident #160 revealed the following information: . not enough staff , especially evening, nights and weekends. . if you ring and they don't answer I expect they are doing something urgent so you fend for yourself. . sometimes you know at the beginning of shift whether your bell will get answered or not depending on whose working or who is not working. . sometimes medications are late and you have to ask for them . as long as two hours. Resident #404. Interview on 2/17/18 at approximately 10:45 a.m. with Resident #404 revealed the following information: . not enough staff, the staff here work hard but just not enough with all the people who need a lot more help then me. . call bells not always answered, we help each other out when they don't come . you can tell when the bells will be answered depending on the staff working that shift. . can be any shift but mostly evening, nights and weekends . you have to wait for medication you are suppose to get at certain times, you end up asking for them. In a 3/5/18 confidential family interview it was revealed that there has been a shortage of nursing staff for building one during the last five months. This family member stated that because of staff being unavailable to provide direct care to residents in building one the resident's families have had to assist residents with their meals and as a safety measure accompany residents ambulating to their rooms. On 3/2/18 Staff D (Unit Manager, RN) who stated during the survey that she manages both building one and building two was observed on one of building one's two units, the Highway Side apparently filling in as a floor nurse throughout the day dispensing medications and assisting resident's with their meals. The following resident and staff interviews were conducted on the east wing: Resident #194 Interview on 2/27/18 at approximately 10:00 a.m. with Resident #194 revealed that the resident had concerns with staffing. Resident #194 stated, I wait over an hour daily for toileting, this place is so short staffed. Resident and family member were present during interview and confirmed Resident #194's staffing concerns. Resident #192 Interview on 2/27/18 at approximately 10:45 a.m. with Resident #192 revealed that Resident #192 stated, I feel that it takes along time for staff to answer my light. Time of day does not matter, there is always a long wait. Resident #55 Interview on 2/27/18 at approximately 11:35 a.m. with Resident #55 revealed, This place is so short staffed, appear to be exhausted. 3-11 is the worst for staff and on 11-7 good luck if anybody comes at all. Resident #55 states, I hear others in the halls yelling out for help, no one comes so I call 0 on the telephone. Resident #196 Interview on 2/27/18 at approximately 12:00 p.m. with Resident #196 revealed, There is not enough staff here, 1 aide and 1 nurse most of the time. Sometimes it takes them so long to come, I have accidents. Resident #161 Interview on 2/27/18 at approximately 12:30 p.m. with Resident #161 revealed, These girls need help here, they are constantly running especially around meal times. It takes forever to get help in this place. Resident #855 Interview on 2/27/18 at approximately 1:30 p.m. with Resident #855 revealed, Sometimes I wait over 2 hours for help here an example, on Sunday I called 911 because I was crying in pain and did not know what else to do. Resident #186 Interview on 2/28/18 at approximately 7:30 a.m. with Resident #186 revealed the following information regarding staffing, I have to wait a long time to get in bed and get out of bed. There are not enough people to help us here. Interview on 2/28/18 at approximately 7:45 a.m. with Staff S, Licensed Practical Nurse revealed, There is not enough staff here, most days there are 1 nurse and 1 Licensed Nursing Assistant. Interview on 2/28/18 at approximately 9:45 a.m. with Staff T, Unit Coordinator revealed there are currently 17 residents on the unit. Four of these residents require a hoyer lift for transfers which requires 2 staff members. Interview on 3/1/18 at approximately 7:15 a.m. with Staff U, Licensed Nursing Assistant revealed, Staffing here really impacts the residents a lot here. 2nd shift showers are missed a lot because there is not enough staff. Interview on 3/1/18 at approximately 7:20 a.m. with Staff V, Licensed Nursing Assistant revealed, We are always short staffed, but the weekends are extremely short. I have had a lot of residents soil themselves because we are with others and can't get to them. Resident #22 Record review of this resident's Quarterly MDS with an Assessment Reference Date of 12/4/17 revealed that the resident's Summary Score for Brief Interview for Mental Status was 15/15. During resident interview on 2/27/18, this resident related that sometimes when staff do not arrive in time when s/he uses the call bell for toileting, s/he is incontinent Resident #80 During interview on 3/2/18, this resident related there are not enough staff, the facility is trying to get more people but haven't, so bedside commodes are not emptied every shift, trays aren't picked up, and beds aren't straightened out. Resident Council notes. 2/28/18 10:58 a.m. Resident Council was held on 2/28/18 at approximately 10:40 a.m. Seven (7) Residents were in attendance, representing 3 of the Facilities Residential Units, all of whom are regular Resident Council members. Staffing was a major concern to these Council members, length of wait times after call bells were activated by residents vary widely. Council members agreed the length of the wait varies directly with the number of LNA's on the floor. They stated they have waited more than a half an hour to an hour to have their needs met. They further stated that coverage is worse on 3 to 11 and 11 to 7 shifts and that on weekends the wait times are atrocious. They mentioned that staff sometimes work through their (personal) lunch time. They also stated that there is a near constant outflow of staff members leaving because of difficult staffing ratios. Some facility staff have actually sought out some residents, including some Resident Council members and tearfully said they do not want to leave but feel they must because they cannot continue to work non-stop. It was stated that 2 nurses were known to residents to give showers; most (nurses) do not seem to have the time to do that. One of the residents stated that some days they are told that no one is available to give showers on some shifts. As residents are only scheduled for 1 or 2 showers per week, if residents miss a scheduled shower, it could be several days before they receive another shower. It was further stated by Resident Council members that some call lights are being shut off by staff reaching behind curtains and canceling the call lights without acknowledging the residents affected. Resident #162 Interview with Resident #162 on 2/27/18 at approximately 10:30 a.m. revealed that she/he often has to stay in bed for the day because the facility does not have enough staff to get her/him out of bed. This resident stated that she/he knows when they are short staffed because the staff will come in and tell her/him that she/he won't be able to get out of bed today because we are short staffed. She/he has not had a negative outcome as a result of having to wait to have her/his call bell answered. Resident #64 Interview with Resident #64 on 2/28/18 at approximately 9:15 a.m. revealed that the resident feels she/he must wait a significantly long time to have her/his call bell answered. She/he stated she/he usually waits a half hour or more and on occasion, an hour or more for her/his call bell to be answered. She/he has not had a negative outcome as a result of having to wait to have her/his call bell answered. Resident #63 Interview with Resident # 93's family member revealed that often times during his/her visit the resident is still in a johnny or in bed when other residents are up and about after 10 a.m. and there are times when this happens after 1 p.m. Resident #124 Interview with Resident #124 on 2/28/18 at 9:48 a.m. revealed that there is not enough staff. She/he has to wait quite a while when she/he rings her/his call bell for assistance, usually a half an hour or more. She/he has not had a negative outcome as a result of having to wait to have her/his call bell answered. A confidential interview on 2/28/18 at approximately 11:30 a.m. with a direct care staff person revealed that staff typically work short staffed and often times cannot meet all the needs of their residents. This staff person stated that staff have convinced their family members to come to work at the facility to try and get enough staff but this option has been exhausted. This person stated that keeping staff is an issue because many staff have left to go to work in Massachusetts where they pay more. This staff person stated that the facility does use agency staff but only for nurses, never LNA's and this is where they are hurting the most. |
2020-09-01 |