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F0689
D

Resident Left Without Accessible Call Light During Shower

Midvale, Utah Survey Completed on 05-28-2025

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 occurred when a resident who required extensive assistance with transfers was left in the shower without access to a call light. The resident preferred to be assisted into and out of the shower but to complete the shower independently, with CNAs checking in periodically. On the day of the incident, a CNA assisted the resident into the shower and then left, leaving the resident unable to reach the call light from the shower chair. The resident completed the shower and attempted to call out for assistance but was unable to get help until another CNA eventually arrived. The resident used the shower head to hit the wall in an attempt to signal for help. Observation of the bathroom revealed that the call light was positioned next to the toilet and was not accessible from the shower chair. Staff interviews confirmed that the resident often took long showers and preferred privacy, with CNAs waiting outside and sometimes completing other tasks while the resident showered. The incident was further corroborated by the resident's medical record, which indicated a need for one-person extensive assistance with transfers.

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