Failure to Ensure Resident Access to Call Light System
Penalty
Summary
The facility failed to ensure that two residents had adequate access to the call light system, which is necessary for them to request staff assistance. One resident, a male with end stage renal disease, hemiplegia, aphasia, and moderate cognitive impairment, did not have a call light cord in his room. He reported that he would yell out to staff if he needed something, as he did not have a way to alert them otherwise. Staff members, including a CNA and an LVN, were unaware that this resident lacked a call light cord and noted that he typically called out or went to the nurses' station when he needed assistance. Another resident, a female with encephalopathy, sepsis, urinary tract infection, and impaired functional abilities, was unable to reach her call light cord because it was tied to the bed repositioning bar on the opposite side from where she was seated in her wheelchair. She stated that she would wait for staff to check on her to communicate her needs, as she could not access the call light. A CNA acknowledged that call light cords tied to beds were often out of reach for residents in wheelchairs but had not reported the issue. The ADON and Administrator were not aware of these deficiencies prior to the survey. Facility policy requires that call lights be plugged in and within easy reach of residents at all times.