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PSYCHIATRIC INSTITUTE OF WASHINGTON 4228 WISCONSIN AVENUE, NW WASHINGTON, DC 20016 May 11, 2020
VIOLATION: STAFFING AND DELIVERY OF CARE Tag No: A0392
Based on daily staffing record review, staffing matrix review, and staff interviews, the nursing staff failed to provide sufficient staffing numbers for nursing care not requiring the services of a licensed registered nurse, to all patients as needed.

Findings included ...

The surveyor conducted an unannounced complaint investigation on 05/08/2020, thru 05/11/2020. On both days, the surveyor reviewed the staffing matrix and the daily staffing sheets for the month of April, 2020, with Employee # 4, Staffing Coordinator. The hospital was found to be fully staffed only on April 11, 2020. The following includes the actual facility staffing, and the staffing matrix required per patient census;

Matrix Staffing: C=Census; D=day; E=evening; N=night; RN= Registered Nurse, PC=Psychiatric Counselor.

Unit 1:
C 0-9; 1 RN d/n, 1 PC d/e/n.
C 10-14; 1 RN d/n, 2 PC d/e, 1 PC n.
C 15-21; 2 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing RN: 2, PC: 2

Unit 2:
C 0-9; 1 RN d/n, 1 PC d/e/n.
C 10-14; 1 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing PC: 2

Unit 3:
C 0-9; 1 RN d/n, 1 PC d/e/n.
C 10-14; 1 RN d/n, 2 PC d/e, 1 PC n.
C 15-21; 2 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing RN: 23, PC: 1

Unit 4:
C 0-9; 1 RN d/n, 1 PC d/e/n.
C 9-13; 1 RN d/n, 2 PC d/e, 1 PC n.
C 13-15; 1 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing PC: 10

Unit 5:
C 0-9; 1 RN d/n, 1 PC d/e/n.
C 10-13; 1 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing PC: 22

Unit 6:
C 0-9; 1 RN d/n, 1 PC d/e/n.
C 10-12; 1 RN d/n, 2 PC d/e, 1 PC n.
C 13-15; 1 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing PC: 17

Unit 7:
C 0-10; 1 RN d/n, 1 PC d/e/n.
C 11-15; 1 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing PC: 3

Unit 8:
C 0-10; 1 RN d/n, 1 PC d, 2 PC e, 1 PC n.
C 11-14; 1 RN d/n, 2 PC d, 3 PC e, 1 PC n.
C 15-21; 2 RN d/n, 3 PC d/e, 1 PC n.
Insufficient monthly staffing RN: 16, PC: 22

Unit 9:
C 0-10; 1 RN d/n, 1 PC d, 2 PC e, 1 PC n.
C 11-15; 1 RN d/n, 2 PC d/e, 1 PC n.
Insufficient monthly staffing PC: 8

The surveyor conducted a face to face interview with Employee # 4, Staffing Coordinator on 05/11/2020, at approximately 12:30 PM. The surveyor queried Employee # 4 about what measures were in place to insure patient care and treatment, at the times when insufficient staffing occurred. Employee # 4 stated that all Nurse Managers are available at all times, to assist with medication administration and Unit monitoring, and that the Day and Evening Supervisors are also available to assist with Unit monitoring and patient activities flow. Employee # 4 acknowledged and agreed with the findings, and stated that the hospital has been hiring "many new employees in all positions, and ongoing staff turnover has been challenging during the Covid-19 health crisis". Also acknowledged was the 10 employees diagnosed with Covid-19, as well as the additional 5 employees on self-quarantine while awaiting testing results. Additionally, there have been new employee training on all units throughout the month of April, adding additional personnel that cannot be listed as scheduled "on the unit", but in fact, they are on the unit training, and helped with any shortages as "extra person (s) on the unit".

The surveyor conducted a face to face interview with Employee 5, House Supervisor on 05/11/2020, at approximately 2:00 PM. The surveyor queried the employee about hospital staffing, and what measures have been taken to ensure safe patient care. Employee #5 stated that She has not seen short staffing lately due to the influx of new employees, and added that the staff have been very cooperative with the staffing of Unit 7, the COVID-19 Unit.

The practice lacked evidence that the nursing staff failed to adequately supply qualified personnel in sufficient numbers, to provide nursing care not requiring the services of a licensed registered nurse.

The surveyor conducted an interview with Employees # 1, Chief Executive Officer, # 2, Chief Nursing Officer, # 11, Quality, and # 4, Staffing Coordinator, on 05/11/2020, at approximately 3:30 PM. At that time, the surveyor showed the finding of insufficient staffing, based on the hospital matrix for the hospital, for the month of April, 2020. All participants in the interview reported that the Nursing Managers and Supervisors have increased their daily involvement in direct patient care, high staff turnover, and the influx of new employees currently in training. Furthermore, the COVID-19 Pandemic, combined with additional pressures due to the pandemic, have been contributing factors in staff turnover. All staff members present at the interview acknowledged and agreed with the finding of insufficient staffing