I recently took on a role at a new AL/IL facility as the administrator. This place is sooooo disorganized. Staffing is out of control. The owners want me to staff at levels that are not conducive to giving good care. They want an unrealistic amount of work out of the CNAs and want me to beat a budget that was in place a year ago when they facility had 20 less residents. They want the CNAs to do all the housekeeping. There is no med tech (the CNAs just give out meds willy nilly) They won't let me staff a med tech for each shift as her sole responsibility. I am pretty sure night shift is sleeping instead of checking in the residents. No one is on a toileting schedule. Residents that are incontinent are wet all the time. Each shift blames the prior. Residents that wet their beds are having their wet beds made up and the families are finding this!The activity director is a royal pain that doesn't want to do anything and acts like a martyr. The receptionist is the biggest gossip and keeps things stirred up with the staff, residents, and families. Gossip is rampant with all the staff. The CNAs tell the families things like, 'I noticed your dad didn't get a shower last night even though he was supposed to' or 'I don't think your mom is getting her meds like she should'. The place is a mess!
I really want to turn this place around and make it work, but where do I start? I am tired of getting yelled at by family members for things that the carestaff aren't doing.
The changes I have made so far are:
1. Assigning one CNA to the meds and the others cover her assignment while she is doing her med pass.
2. Working the budget out to cover a FT housekeeper to clean.
3. Giving the CNAs a detailed assignment sheet of who they have and what they are expected to do.
My question is, What else can I do to turn this place around and how do I hold the CNAs accountable for not doing things when they have a detailed assignment AND when they blame wet beds and pullups on another shift?