Call Light Not Accessible to Resident Requiring Assistance
Penalty
Summary
Facility staff failed to ensure that a resident's call light was within reach, as required by facility policy and the resident's care plan. The resident, who was cognitively intact but required substantial to maximal assistance for most activities of daily living and had left hand contractures, was observed attempting to sit up in bed and searching for the call light to request assistance. The call light was found hanging on top of the overhead light, far from the resident's reach, making it inaccessible for the resident to use when needed. Interviews with staff, including a CNA, the ADON, and the DON, confirmed that the call light was not within reach and that this would prevent the resident from being able to request help. The resident's care plan specifically instructed staff to ensure the call light was within reach and to encourage its use for assistance. The facility's policy also required that all residents have the call light system available and easily accessible at the bedside or another reasonable location.