Failure to Ensure Call Bell Accessibility for Resident at Risk for Falls
Penalty
No penalty information released
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
A resident who was identified as being at risk for falls experienced an unwitnessed fall and was found in front of their wheelchair next to their bed. Review of the resident's care plan indicated that staff were required to ensure the call light was within reach and to encourage the resident to use it for assistance as needed. However, documentation from the post-fall assessment confirmed that the call bell was not within the resident's reach at the time of the incident. This failure to follow the care plan intervention contributed to the resident's fall.