Failure to Ensure Functional Call Light Systems and Emergency Call Cord Accessibility
Penalty
Summary
The facility failed to reasonably accommodate the needs and preferences of residents by not ensuring that call light systems were functional and accessible. One resident, admitted with diagnoses including spondylosis, scoliosis, and type 2 diabetes, was assessed as cognitively intact and totally dependent on staff for toileting and transfers. Despite being encouraged to use the call light for assistance, the resident reported that the call light did not work and that calls for help were not answered promptly. Observations confirmed that the call light outside the resident's door did not illuminate and calls for assistance went unanswered for an extended period, with staff present in the hallway not responding. Interviews with staff revealed that there was no unit or ward clerk to monitor the call system, and maintenance was unaware of the malfunction until the survey began. The DON confirmed the call light was not functioning and that the resident's needs were not accommodated. Additionally, the emergency call light cord was missing in a hall bathroom accessible from two rooms. This was confirmed during an observation and by an LPN, who acknowledged that the emergency call light cord should have been in place. These failures resulted in residents not having reliable means to request assistance, compromising the facility's ability to meet their needs in a timely manner.