Failure to Timely Respond to Resident Call Light
Penalty
Summary
A deficiency was identified when a resident activated their call light at 12:11 PM, and it remained unanswered for over an hour and a half, with no staff responding until at least 1:43 PM. The resident reported that call lights are often not answered when activated, sometimes remaining on all night, and noted that the call light does not illuminate over the door but only appears on a screen at the desk, which was described as barely working. Observations confirmed that the call light was still activated at multiple intervals, and no staff entered the room to address the resident's needs during this period. Interviews with staff revealed reliance on a system at the nurses' station to monitor call lights, with staff indicating they check the system as long as it is functioning properly. The resident involved had diagnoses of General Anxiety Disorder and Chronic Kidney Disease and required assistance with bed mobility and transfers. The resident was cognitively intact, as indicated by a Brief Interview for Mental Status score of 14/15. Review of resident council notes from the previous six months showed ongoing concerns about timely call light response, particularly during the midnight shift. Facility policy states that call lights should be answered promptly by available staff, but this expectation was not met in the observed incident.