Delayed Call Light Responses and Inaccessible Call Lights
Penalty
Summary
The facility failed to provide timely responses to resident call lights and did not ensure call lights were within reach for all residents as required by policy. One resident with severe cognitive impairment and a history of falls was observed seated in a recliner with the call light placed on the bed, out of her reach, despite her care plan directing staff to keep the call light accessible. When the resident needed assistance to use the bathroom, she was unable to summon help until a staff member was alerted by the surveyor. The staff member acknowledged that the call light had not been placed on the resident's chair as it should have been. Additionally, two other residents reported and experienced significant delays in staff response to their call lights, with documented wait times frequently exceeding 20 minutes and sometimes reaching over 40 minutes. One resident, who was at risk for falls, stated that staff would sometimes turn off the call light and promise to return but failed to do so. Another resident, with a history of surgical repairs and chronic conditions, kept a log of delayed responses and reported incontinence episodes as a result of the delays. Review of computerized call light logs confirmed multiple instances of prolonged response times, contrary to the facility's policy requiring prompt and courteous responses to call lights.