Deficient Call Light System Fails to Alert Staff for Resident Needing Assistance
Penalty
Summary
A deficiency was identified when the facility failed to ensure that the call light system was functioning properly for a resident who required assistance with activities of daily living. The resident, who had a history of cerebral infarction, hypertensive heart disease, and dysphagia, was cognitively intact and needed partial assistance with transfers and toileting. During an observation, it was found that while the call light at the bedside would illuminate the light above the room entry door and the communication panel at the nurse's station, no audible alarm sounded. Additionally, there was no manual hand bell available for the resident to use to call for assistance. Interviews with staff revealed that the call bell system had not been working correctly for some time, with issues such as the alarm not sounding and lights not functioning in certain rooms. Staff reported that, due to these ongoing issues, they relied on rounding every two hours to check on residents. The resident confirmed he could engage the call light but did not hear a noise and sometimes experienced delays in staff response. Maintenance and administrative staff acknowledged the persistent problems with the call bell system and indicated that the issue was known and under review.