Failure to Respond Timely to Resident Call System
Penalty
Summary
The facility failed to ensure that two of four sampled residents received care in accordance with professional standards by not answering the resident call system in a timely manner. One resident, who was dependent on staff for most activities of daily living due to chronic respiratory failure, mobility issues, and generalized anxiety disorder, reported that call lights sometimes went unanswered for half an hour or more, leading to feelings of unsafety, frustration, and anxiety. Direct observation confirmed a delay of seven minutes in responding to this resident's call light. Staff interviews acknowledged that call lights should be answered immediately, but the assigned CNA was unaware of the call due to assisting other residents at the time. Another resident, with diagnoses including metabolic encephalopathy, COPD, and chronic kidney disease, also required significant assistance and reported that call lights often took a couple of hours to be answered. This resident stated that staff frequently cited short staffing as the reason for delays and expressed feelings of neglect. The facility's policies require prompt response to call systems and provision of care based on comprehensive assessments, but these standards were not met, as evidenced by resident reports, staff interviews, and direct observation.