Failure to Ensure Resident's Call Device Accessibility
Penalty
Summary
The facility failed to provide reasonable accommodation for a resident by not ensuring the resident's call device was within reach while the resident was in bed. This deficiency was identified for a resident diagnosed with Osteomyelitis of the Vertebra, Sacral, and Sacrococcygeal Region, which is an infection of the bone. On two separate occasions, the surveyor observed the resident's call device on the floor, outside of the resident's reach. The facility's policy, effective since March 2020, states that a call bell system is utilized to allow residents to call for staff assistance. Despite this policy, the resident's call device was not accessible, indicating a failure to accommodate the resident's needs and preferences as required.
Plan Of Correction
F558- Reasonable Accommodations What corrective action will be accomplished for those residents affected by the deficient practice? Unit Manager ensured resident's call bell was placed in close proximity to the resident #320 on 12/16/2024 and 12/20/2024. How will the facility identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken? All residents have the potential to be affected by this deficient practice. Unit Managers completed an audit and if a call bell was not in close proximity of the resident, the call bell was moved toward the resident. What measures will be put into place or what systemic changes will be made to ensure the deficient practice will not recur? The Call bell policy was reviewed. Clinical staff were educated on the importance of ensuring residents' call bells are in reach of residents. Unit managers will monitor call bells to ensure they are in close proximity of residents. How will the corrective action be monitored to ensure the deficient practice will not recur? Director of Nursing or designee will complete an audit of the location of resident call bells to ensure they are in close proximity of the resident. The Audit will be completed once a week for 30 days, then monthly x3. The results of the audit will be reviewed at the monthly QAPI team chaired by the facility administrator.