Failure to Maintain Functioning Call Light System for Two Residents
Penalty
Summary
The facility failed to ensure a functioning call light system was available for two residents who required assistance. For the first resident, who had diagnoses including acute and chronic respiratory failure, major depressive disorder, epilepsy, generalized anxiety disorder, and required help with personal care, both the resident and a CNA observed that the call light in the resident's room did not activate the external light or provide any visible indication when pressed. This was confirmed during interviews and direct observation, with the CNA acknowledging the malfunction. For the second resident, who had Alzheimer's disease, dysphagia, and other medical conditions, a similar issue was observed. The CNA attempted to activate the call light in the resident's room, but it did not function. The CNA stated an intention to document and report the issue. The facility's policy requires that each resident have access to a working call light or alternative communication device in their room, bathroom, and bathing area, and that staff promptly report and address any malfunctions. However, these requirements were not met for the two residents reviewed.