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F0725
E

Failure to Provide Timely Response to Resident Call Lights

Missouri Valley, Iowa Survey Completed on 06-12-2025

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 provide adequate nursing staff to ensure timely response to resident call lights, resulting in delays for multiple residents. Observations, interviews, and call light log reviews revealed that several residents experienced wait times exceeding 15 minutes on numerous occasions when requesting assistance. For example, one resident with diabetes, end stage renal disease, and vascular dementia reported that it often took longer than 15 minutes for staff to respond to her call light, with documented instances of response times ranging from 16 to 45 minutes over several days. The resident also stated that staff told her they did not have time to assist her with being put to bed. Another resident with hemiplegia, muscle weakness, and anxiety disorder was observed waiting over 15 minutes for assistance to use the toilet, despite staff being aware of her need. The call light log for this resident also showed multiple instances of delayed responses, some exceeding 40 minutes. Staff interviews confirmed that the facility's expectation was to answer call lights within 15 minutes, but acknowledged that this standard was not consistently met. The DON and Administrator both stated that call lights should be answered as soon as possible, and that grievances regarding call light response times had been received. Additional residents reported similar experiences, including one who had to wait 45 minutes on the toilet during a shift change and another who stated that call lights frequently took over 15 minutes to be answered. The facility's policy requires staff to answer call lights in a timely manner, but the documented delays and resident reports indicate that this policy was not consistently followed, resulting in unmet care needs for several residents.

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