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F0558
D

Call Light Not Accessible for High Fall Risk Resident

Newhall, California Survey Completed on 09-02-2025

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 resident with a history of hemiplegia and hemiparesis following cerebrovascular disease, as well as type 2 diabetes mellitus and essential hypertension, was identified as having severely impaired cognitive skills and a high risk for falls. The resident's care plan specifically required that the call light be kept within reach and that staff encourage its use for assistance, with prompt responses to all requests. However, during an observation, the call light was found rolled up and hung on the wall at the head of the resident's bed, out of the resident's reach. The Director of Nursing confirmed that the call light was not accessible to the resident and acknowledged that the call light is a primary means for residents to communicate with staff. Facility policy also required that call lights be accessible to residents when in bed, on the toilet, or in the shower. The failure to ensure the call light was within reach represented a lack of reasonable accommodation for the resident's needs and preferences, as outlined in both the care plan and facility policy.

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