The OIG conducted an inspection to assess the merit of allegations regarding poor quality care and management on the long-term care (LTC) spinal cord injury (SCI) unit at the Louis Stokes VA Medical Center (facility) in Cleveland, OH. We did not substantiate allegations regarding infection control infractions. However, we found that staff nurses did not consistently document resident care and nurse managers had not taken effective actions in response to conduct, absence, and other issues. We also found understaffing on all shifts and that float staff pulled from other units during staffing shortages lacked the training and competencies to work with this complex and challenging patient population. We recommended that the Facility Director ensure that: staffing levels on the LTC SCI unit are consistent with Veterans Health Administration requirements and the facility’s SCI Master Nurse Staffing Plan, LTC SCI nursing staff consistently provide and document resident care, LTC SCI nurse managers take action to investigate and address conduct related issues, and float staff assigned to the LTC SCI unit have the training and competencies required for the unit.