Failure to Respond to Call Lights in a Timely Manner
Penalty
Summary
The facility failed to answer call lights in a timely manner for all six residents reviewed for timely assistance. Multiple residents reported extended wait times for staff response after activating their call lights, with some instances exceeding an hour. Residents described situations where they experienced pain, discomfort, or soiled themselves due to the delay in receiving assistance, particularly with toileting and transfers. Several residents also observed staff walking past rooms with active call lights without stopping to help or acknowledge the request. Residents interviewed had significant medical conditions, including fractures, diabetes, chronic kidney disease, heart failure, and impaired mobility, requiring varying levels of assistance for activities of daily living. Despite care plans indicating the need for prompt assistance and the use of call lights, residents consistently reported delays, especially during night shifts or weekends. Some residents stated they had to wait for extended periods before being assisted, leading to accidents and prolonged discomfort. Certified Nurse Aides (CNAs) interviewed confirmed that staffing levels often resulted in delays, particularly when multiple residents required two-person assistance. CNAs reported that it was not uncommon for residents to wait 20 to 45 minutes, or longer, depending on the care needed and the number of residents waiting. Resident council minutes also documented complaints about insufficient CNA assistance and lack of staff presence after meals. The facility's policy requires timely and courteous responses to call lights, but this expectation was not met according to both resident and staff accounts.