Call Bell Inaccessibility for Resident with Stroke
Penalty
Summary
A deficiency was identified when a resident with a recent stroke, who had limited control of his left leg and no control of his left arm, was repeatedly observed without access to a call bell. Clinical records indicated the resident was alert, oriented, able to make his needs known, and at risk for falls, with a care plan intervention requiring the call bell to be within reach and reminders to use it for assistance. On multiple occasions, the call bell was found out of the resident's reach, either on the nightstand or on the floor, while the resident was in bed. The resident reported being unable to find or use the call bell because it kept falling off the bed and stated he relied on his roommate for assistance. Staff interviews confirmed the call bell should have been clipped to the bed and accessible at all times.