Failure to Ensure Call Lights Within Reach for Residents at Risk for Falls
Penalty
Summary
Surveyors identified that the facility failed to ensure call lights were within reach for two residents, both of whom were care planned as being at risk for falls. For one resident with severe cognitive impairment and multiple diagnoses including dementia with agitation and paranoid schizophrenia, the call light was observed hooked to the privacy curtain and out of reach while the resident was lying in bed. The activity director confirmed that the resident uses the call light and verified it was not accessible at the time of observation. The resident's care plan specifically required that the call light be within reach and that the resident be encouraged to use it for assistance. For another resident, who was cognitively intact and had diagnoses including Parkinson's disease, muscle weakness, and difficulty walking, the call light was found lying on the bed and out of reach while the resident was sitting in a chair and expressing a need to use the bathroom. The activity director again confirmed the call light was not accessible. Facility policy required that call lights be within easy reach of residents when in bed or confined to a chair, but this was not followed in these instances.