F0919

E

Failure to Provide Call Lights in Memory Care Unit

Henryetta, Oklahoma Survey Completed on 01-20-2026

Penalty

No penalty information released

Summary

Surveyors found that the facility failed to ensure operational and available call lights for all 14 occupied rooms on the memory care unit, where 22 residents resided. During a tour of the unit on 01/13/26 between 9:01 a.m. and 9:14 a.m., each of the 14 observed rooms was noted to have no call light. An undated Call Light Policy stated that a calling system must be available for each resident in the nursing home, but this was not in place on the memory care unit.

In interviews, a CNA reported being told that the rooms did not have call lights because they were considered a strangulation risk, and stated that if a resident needed staff assistance they would have to holler out. The ADON similarly stated that the memory care unit did not have call lights because they were viewed as a safety hazard. These observations and statements show that the facility had intentionally not provided call lights in the memory care unit bathrooms and bathing areas despite its own policy requirement that a calling system be available for each resident.