Failure to Ensure Call Lights Accessible to Residents
Penalty
Summary
The facility failed to ensure that the call light systems in the rooms of three residents were accessible, as required by their care plans and facility policy. Observations revealed that one resident's call light was on the floor and out of reach while he was lying in bed, despite his need for extensive assistance and his status as a fall risk. Another resident, who also required extensive assistance and had a history of falls, was found with his call light pad under the bed and out of reach. This resident reported being unable to contact staff for help when he was wet earlier in the morning. A third resident, who required supervision or touching assistance and was a fall risk, was heard calling for help from his room; his call light was found hanging on the wall, wrapped around an air freshener, and not accessible to him. Staff interviews confirmed that the call lights should have been placed within reach of the residents, in accordance with their care plans and the facility's policy. Staff acknowledged that the improper placement of call lights could prevent residents from alerting staff when assistance was needed. The facility's policy specifically required that call lights be placed within reach of residents when staff leave the room.