57% approval rating in my opinion means that this organization needs to restructure. There staff turn over must be outrageous. The money that they are spending on training new staff could be used to give good staff a raise. This must reflect on the care that the seniors receive. I cannot believe that people that are unhappy in their jobs are going above and beyond.
Communication of problems to the manager. Action to improve the situation
I would clean up HR by hiring some forward thinking people advocates who could be heard within the hierarchy. I would ask the CEO and COO to spend time working at the retirement homes to see just what these folks go through. The management team is too far removed from the actual process of caring for seniors. $$$
Base decisions on what is actually good for the residents, not just the bottom line