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F0919
D

Call Lights Out of Reach for Residents with Mobility Impairments

Carmichael, California Survey Completed on 05-23-2025

Penalty

No penalty information released
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The penalty, as released by CMS, applies to the entire inspection this citation is part of, covering all citations and f-tags issued, not just this specific f-tag. For the complete original report, please refer to the 'Details' section.

Summary

The facility failed to ensure that call lights were accessible to three residents with significant mobility impairments. One resident with hemiplegia and diabetes mellitus was unable to locate his call light, which was found hanging over the bed rail and lying under the bed, out of reach. Another resident with quadriplegia and spinal fusion had his call light wrapped around the bed rail, also out of reach. A third resident with hemiplegia and muscle atrophy similarly had his call light wrapped around the bed rail and could not access it. All three residents confirmed during interviews that they could not reach their call lights and would be unable to notify staff in an emergency. A Certified Nursing Assistant (CNA) confirmed that the call lights for these residents were out of reach and acknowledged that call lights should be placed by the resident's hand for safety. The Director of Nursing (DON) also confirmed that call lights should always be within reach to allow residents to call for assistance or in case of emergency. Review of the facility's policy indicated that call lights are to be accessible to residents when in bed.

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