Failure to Ensure Call Lights Accessible to Residents
Penalty
Summary
The facility failed to ensure that call lights were accessible to residents as required by their care plans. One resident, who is blind and has multiple diagnoses including encephalopathy, weakness, and reduced mobility, was observed trying to locate his call light, which was found out of reach between the siderail and the floor. The resident expressed difficulty in finding the call light, and his care plan specifically required that the call light be kept within reach due to his self-care deficits and moderate cognitive impairment. Another resident, who was lying on a low air loss mattress and has a history of falls, osteoarthritis, and cognitive impairment, was unable to locate the call device. The call device was found stuck on the headboard and not within the resident's reach. The care plan for this resident also required that the call light be placed within reach due to fall risk and decreased safety awareness. Facility policy and CNA job descriptions further specify that call lights should be kept within easy reach of residents, but these procedures were not followed in these instances.