Failure to Ensure Resident Access to Call Light System
Penalty
Summary
Facility staff failed to provide reasonable accommodation for a resident by not ensuring the call system was within the resident's reach, as required by facility policy and the resident's care plan. Multiple observations over two days showed the call light hanging on the wall behind the resident's bed, inaccessible to the resident both while lying down and sitting up. The resident, who had a history of falls, muscle weakness, and anxiety disorder, confirmed during an interview that they were unable to reach the call light and had to resort to yelling for assistance. Staff interviews revealed awareness of the issue, with a CNA noting that the call light's clip was broken and should be fixed to allow it to be attached to the bed. The CNA acknowledged that the lack of access to the call light would cause the resident distress and prevent them from calling for help. The DON also confirmed that the resident should have access to the call light at all times and that staff are responsible for ensuring it is within reach.