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F0919
E

Call Lights Not Accessible to Residents

Carmichael, California Survey Completed on 08-07-2025

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

The facility failed to ensure that call lights were within reach for two of five sampled residents, resulting in the potential for unmet care needs. One resident, admitted with multiple sclerosis, muscle weakness, and moderate cognitive impairment, was observed unable to access her call light due to it being blocked by a pillow. Despite attempts to reach it, she was unsuccessful, and both a CNA and a licensed nurse confirmed the call light was out of reach. The resident expressed a desire to have the call light accessible. The care plan for this resident specifically indicated that the call light should be within reach due to her risk for falls and limited mobility. Another resident, with a history of cerebral infarction, muscle weakness, dysphagia, and severe cognitive impairment, was found with the call light stored in a drawer, out of reach. When asked to use the call light, the resident was unaware of its location. Both a licensed nurse and a CNA confirmed the call light was not accessible and stated it should be within reach. The care plan for this resident also required the call light to be accessible due to high fall risk. The facility's policy stated that call lights must be accessible to residents in bed, on the toilet, or in bathing areas. Interviews with staff and the administrator confirmed the expectation that call lights should always be within reach unless staff are present and assisting the resident.

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