Failure to Ensure Call Light Accessibility for Resident
Penalty
Summary
A deficiency was identified when a resident was repeatedly observed without access to their call light while seated in a wheelchair in the middle of their room. On two separate occasions, the call light was found on the floor or on the opposite side of the bed, out of the resident's reach. The resident reported being unable to contact staff for assistance during the day and expressed anxiety at night due to uncertainty about call light accessibility, sometimes having to yell for help. During one observation, the resident needed to use the restroom but could not summon assistance due to the inaccessible call light. The resident's clinical record indicated diagnoses of dementia, orthostatic hypotension, and muscle weakness, with a recent BIMS evaluation showing cognitive intactness. The MDS assessment documented the resident's dependence on staff for toileting and transfers, and the care plan included an intervention to keep the call light within reach due to fall risk. Facility policy also required staff to ensure call lights were accessible to residents. An RN confirmed that it was the responsibility of any staff member entering the room to ensure the call light was within reach.