Failure to Respond Timely to Call Lights for Dependent Residents
Penalty
Summary
The facility failed to respond to call lights in a timely manner for two dependent residents. One resident, who had hemiplegia, hemiparesis, and Parkinson's disease, was observed waiting in her wheelchair for over 55 minutes for staff to change her wet brief. Despite activating her call light multiple times, staff either turned off the call light and left without providing care or informed her that care could not be provided during lunch due to contamination concerns. Staff, including CNAs and an LPN, were observed in the hallway and at the nurse's station but did not respond to the resident's repeated requests for assistance. The resident's care plan required assistance with toileting and incontinence care, and staff were expected to check her every two hours for incontinence. Another resident, who had a recent below-the-knee amputation and was dependent for toileting and transfers, reported that staff were often slow to respond to his call light, resulting in accidents and the need to wear an adult brief. This resident was also assessed as being cognitively intact and required assistance with elimination and incontinence care as needed. Both residents' care plans included keeping call lights within reach and providing timely assistance. The Director of Nursing Services stated that call light response times should not exceed five minutes, and the Executive Director acknowledged that it was unacceptable for call lights to go unanswered for extended periods. However, the facility did not have a specific policy regarding call light response times.