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F0558
D

Call Light Accessibility Not Ensured for Cognitively Impaired Resident

Three Rivers, Michigan Survey Completed on 10-30-2025

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

The facility failed to ensure that call lights were within reach for a resident who was severely cognitively impaired and required assistance with most activities of daily living, as documented in the Minimum Data Set. Multiple observations showed that the resident's soft-touch call light was either under the sheet at waist level or clipped to the fitted sheet at the head of the bed, both out of the resident's sight and reach. During interviews, the unit manager acknowledged that the call light should have been accessible and explained that staff placed it under the sheet so the resident might activate it by rolling onto it, but confirmed that staff should not have done this.

An unhandled error has occurred. Reload 🗙