Carrington Place of St. Pete was cited after the facility “failed to ensure nurse’s aides demonstrated competencies” and did not “provide the resources and orientation necessary to provide care and services to vulnerable residents.” The lack of training resulted in two residents soiling their pants because the staff did not assist them to the restroom.
Initial Observations and Incidents
The investigator of this citation conducted several observations of this nursing home facility. During one observation, the investigator noted a resident sitting in the hallway in her wheelchair and saying something every time someone would walk by. When finally asked what she was saying, the resident stated very softly, “I had to go to the bathroom so bad that I peed myself. I have been trying to get someone to take me to the bathroom and no one will stop and talk to me.” The resident then began to cry.
A Certified Nurse’s Aide (CNA), Staff C, was observed walking down the hallway in the direction of the distressed resident with a tray of food. The resident called out Staff C so she could get help going to the bathroom. In response, Staff C called to one of her colleagues, Staff A, to help the resident and kept walking down the hallway. Staff A told the investigator, “I’m new here. I do not even know where her room is.” She also continued walking down the hall without assisting the resident.
At this point, the investigator found the Director of Nursing (DON), who was coming down the same hallway. She noted the resident’s state and told Staff C to “put down that food tray and come help me transfer [the resident].” An interview was conducted with the DON after this incident. She said “we need to have a little talk with Staff A.”
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Review of Staff Competencies
In response to the DON’s comments, the investigator reviewed the personnel file for Staff A, who was instructed by the CNA with the food tray to help the resident. The files revealed Staff A was not a certified nurse’s aide. She had completed CNA training and passed the written portion, but she had yet to complete the practical portion of the exam. According to the citation, there was also “no evidence of a signed job description, orientation or check off lists for validated or non-validated competencies.”
The nursing home’s facility policy titled “Nursing Services and Sufficient Staff” states the following in regards to education:
It is the policy of this facility to provide staff with appropriate competencies and skill sets to assure resident safety and attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident… The facility must ensure that nurse aides are able to demonstrate competency in skills and techniques necessary to care for residents’ needs, as identified through resident assessments, and described in the plan of care.
Nursing homes must fully equip their staff with the supplies and education they need to take care of residents. When proper training is not given, vulnerable residents are put at risk for physical or emotional turmoil.
Observations and Interviews
The investigator then interviewed the resident about the situation. She said, “I had been waiting to go to the bathroom for a long time. They just kept walking by me. I can go in the toilet, but they have to help me get there. They put this thing on me (pointing to her groin area) and tell me to go if I need to.”
A couple of days later, the investigator returned to the nursing home to conduct another observation. Around 7:40 am, the investigator saw a resident sitting in her specialized chair with white spots on her pants. There was a wet spot noted around the groin area as well. The resident was shouting loudly “doctor, doctor” over and over. The resident remained in this state until 10:52 am. The investigator noted there was still a wet spot on the resident’s groin; it had grown larger, and there was a foul odor.
An interview was conducted with a staff member regarding the resident’s soiled state. She stated, “I do not know if she is mine or not. I do not even know who she is.” Another staff member chimed in to say she knew where her room was, but she did not know much more than that.
An interview was then conducted with several CNA’s. They confirmed they had not received any orientation to the facility, although they were supposed to. One of the CNA’s said, “We did not orient with another aide… I have been here a couple of times and they have never given me any orientation.” Another CNA echoed similar sentiments, saying, “I do not know how we would find out what the residents we are taking care of need. I just jump in and do the best I can.”
In response to the investigator’s questions, the Assistant Director of Nurses (ADON) stated the following:
The care the aides are to provide to the residents is in the computer under aide tasks. I am really not sure how to get into that information. I am new here and still learning the computer system myself. They should get report from the aides going off the shift they come in to replace. I do not know anything about an agency nurse giving report to another agency nurse. That should not happen. I am pretty sure they are provided orientation before they are given an assignment.”
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Facility Orientation Process
The investigator looked into the ADON’s comments about orientation by talking with a Licensed Practical Nurse who has been with the facility for three years. She offered the following information:
I am a PRN (as needed) here and know the normal routine for [the resident] is after she eats breakfast, she needs to be toileted. The aides who work here know right after breakfast, like clockwork, she needs to go to the bathroom. The agency aides yesterday did not know that. There is no orientation; there should be. That issue yesterday, should not have happened. This is a hard unit and a lot of the residents here have multiple issues and have some type of cognitive issues. It is not an easy unit to work on.
The investigator spoke with the Nursing Home Administrator regarding the orientation process. The administrator said, “The Unit Managers of the floor complete their competencies and the Director of Nurses or the Assistant Director of Nurses looks at it and, if it is OK, signs it. Their competencies and orientation are attached to their job descriptions in their HR files.” A review of the employee records faxed to the investigator revealed there was “no evidence of a signed job description, orientation, or check off lists for validated or non-validated competencies.”
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