Failure to Respond Timely to Resident Call Lights
Penalty
Summary
The deficiency involves facility staff not consistently answering resident call lights within a reasonable amount of time, particularly during evening and night shifts. Multiple residents with intact cognition, as indicated by Brief Interview for Mental Status (BIMS) scores of 15, reported extended waits after activating their call lights for assistance with toileting and personal care. One resident stated that after being assisted to the toilet by a CNA, she activated her call light within five minutes but did not receive help back to bed for approximately 45 minutes. Another resident reported turning on the call light for toileting assistance and waiting about 30–45 minutes without a response, ultimately going to bed without being properly cleaned. A third resident reported experiencing prolonged call light response times for a long period during evenings and overnights, including an incident where he choked on mucous and waited about 15 minutes for staff to respond, during which he feared he was choking to the point of death before clearing it himself. Resident Council minutes from a recent month documented concerns that staff were turning off call lights, wearing earbuds during care, and that there were long wait times for call lights to be answered. The facility census was reported as 81 residents. The DON and CNAs interviewed stated that staff were expected to respond to call lights within an appropriate time and as quickly as possible, and the facility’s call light policy directed all staff who see or hear an activated call light to respond and notify appropriate personnel of the resident’s need.
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