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F0919
D

Call Light Not Accessible to Dependent Resident

Lynwood, California Survey Completed on 12-12-2025

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 with significant physical and cognitive impairments did not have access to a working call light within reach. The resident, who was dependent on staff for all activities of daily living due to muscle wasting, atrophy, and muscle weakness, was observed to be unable to locate her call light and expressed distress over not being able to call for assistance. The resident required supervision or full assistance for eating, dressing, hygiene, toileting, and transfers, and was always incontinent of urine. During interviews, both a Licensed Vocational Nurse and a Certified Nurse Assistant confirmed that the call light was stuck under the mattress and not accessible to the resident. The CNA stated that the resident had recently been moved to the room and the call light's placement was overlooked. Facility policy requires that call lights be placed within easy reach of residents, but this was not followed in this instance, resulting in the resident being unable to request help when needed.

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