F0558

D

Failure to Provide Usable Call Light for Dependent Resident

Bloomfield Hills, Michigan Survey Completed on 01-14-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide an appropriate, usable call light for a bedbound resident with significant physical and cognitive impairments. A complaint to the State Agency alleged that this resident, who was unable to use her hands, did not have a proper call light and that it was difficult for staff to know when she needed assistance. On two separate observations, the resident was seen lying in bed with her head leaned to the left and a standard push-button call light clipped to her blanket. During one observation, a family member present could not confirm whether the resident was able to use the call light. During another observation, the resident indicated by slightly shaking her head that she could not press the call light button.

In an interview, the unit manager RN initially stated the resident could use a standard push-button call light, but upon direct observation with the resident, the RN attempted to place the call light in the resident’s hand and was unable to do so, acknowledging the resident could not hold it and would need a different type of call light. The DON reported that if staff noticed a resident was unable to use a standard call light, the resident should be assessed for an appropriate call light. Record review showed the resident was admitted with contractures, functional quadriplegia, and muscle wasting and atrophy, and an MDS assessment documented unclear speech, severely impaired cognition, and total dependence on staff for all ADLs. The facility’s own policy on call light accessibility stated that each resident would be reviewed for unique needs and preferences to determine any special accommodation needed to utilize the call light system, but this was not carried out for this resident.