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F0919
D

Delayed Call Light Response and Failure to Address Resident Needs

Westland, Michigan Survey Completed on 05-29-2025

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

A deficiency was identified when a resident with a history of stroke, functional quadriplegia, and anxiety, who required substantial assistance for all activities of daily living and mobility, experienced significant delays in having their call light answered. The resident reported that after activating the call light, it often took a very long time for staff to respond, and expressed concern that frequent use of the call light was discouraged by staff. During observation, the resident activated the call light and waited 33 minutes before their needs were addressed. During this period, a registered nurse entered the room, was informed of the resident's needs, and stated they would notify the assigned CNA. Another CNA entered, turned off the call light, and left without addressing the resident's needs, stating the assigned CNA would be there soon. The resident remained wet and anxious until the assigned CNA arrived and provided assistance. Interviews with nursing staff revealed that the facility's expectation for answering call lights is within 10 to 20 minutes, and that the person responding to the call light is expected to address the resident's needs directly, rather than turning off the light and leaving. The observed delay and failure to address the resident's needs upon initial response did not meet these expectations, resulting in the resident remaining in discomfort and distress for an extended period.

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