Stay Ahead of Compliance with Monthly Citation Updates


In your State Survey window and need a snapshot of your risks?

Survey Preparedness Report

One Time Fee
$79
  • Last 12 months of citation data in one tailored report
  • Pinpoint the tags driving penalties in facilities like yours
  • Jump to regulations and pathways used by surveyors
  • Access to your report within 2 hours of purchase
  • Easily share it with your team - no registration needed
Get Your Report Now →

Monthly citation updates straight to your inbox for ongoing preparation?

Monthly Citation Reports

$18.90 per month
  • Latest citation updates delivered monthly to your email
  • Citations organized by compliance areas
  • Shared automatically with your team, by area
  • Customizable for your state(s) of interest
  • Direct links to CMS documentation relevant parts
Learn more →

Save Hours of Work with AI-Powered Plan of Correction Writer


One-Time Fee

$49 per Plan of Correction
Volume discounts available – save up to 20%
  • Quickly search for approved POC from other facilities
  • Instant access
  • Intuitive interface
  • No recurring fees
  • Save hours of work
F0565
D

Failure to Address Resident Council Concerns Over Prolonged Call Light Response Times

South Bend, Indiana Survey Completed on 04-28-2025

Penalty

No penalty information released
tooltip icon
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 effectively address and resolve concerns raised by the Resident Council regarding prolonged call light response times. During a meeting with the surveyor, all seven residents present confirmed that the Resident Council had repeatedly complained about long wait times for call lights to be answered, with two residents reporting ongoing delays. One resident specifically stated he had waited as long as an hour for assistance in recent weeks. Review of Resident Council meeting minutes showed that these concerns had been documented multiple times over the past year. The Executive Director (ED) acknowledged awareness of the issue and identified two potential causes: the call light system required a 2-3 second hold to reset, and some staff ignored alarms, assuming they had already been addressed. Although the facility had included call light response times in its QAPI meetings and implemented Performance Improvement Projects (PIPs) in response to complaints, the problem persisted. The ED reported that staff had been educated on the system, but could not provide documentation of this education. Additionally, interventions such as running daily call light reports and having administrators monitor pagers were implemented, but there was no monitoring during evening and night shifts, and staff did not follow up with residents who experienced long wait times. A review of call light reports revealed numerous instances where response times exceeded 30 minutes, with several cases surpassing one or even two hours. The ED was unable to define a reasonable maximum response time, stating it would vary depending on staff workload. Despite repeated interventions and ongoing monitoring, the facility did not resolve the issue, and residents continued to experience significant delays in call light responses.

An unhandled error has occurred. Reload 🗙