Absolutely enforce sanctions! Staffing is difficult but there is no excuse. The ALs and nursing homes know staff call outs are approx 20% everyday and holidays are greater at close to 50%. Hence you schedule more people to cover but that isn’t done. Having one person be responsible for 18 people (yes - happened to my dear momma) is ridiculous. The state needs to have statutes with required staffing. In support, VDH needs to do workshops on how to keep staff, how to discourage call outs, and how to schedule coverage.