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F0919
D

Call Light Not Accessible to Dependent Resident

Pasadena, California Survey Completed on 05-23-2025

Penalty

No penalty information released
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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 deficiency was identified when a resident, who had been admitted with diagnoses including cerebral infarction, anxiety disorder, and chronic pain syndrome, was found to have their call light lying on the floor beneath the bed, out of reach. The resident's Minimum Data Set indicated intact cognitive skills but significant physical impairments, including upper and lower extremity impairment on one side and dependence on staff for most activities of daily living, including mobility and hygiene. During observation, the resident was lying in bed and unable to access the call light. Interviews with facility staff, including a CNA, LVN, and the DON, confirmed that facility policy requires call lights to be within reach of residents to maintain safety. The resident's care plan also specified that the call light should be kept within easy reach and answered promptly. Review of the facility's policy and procedure further supported this requirement, stating that the call device must be placed within the resident's reach before staff leave the room. Despite these policies and care plan interventions, the call light was not accessible to the resident at the time of observation.

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