F0558

E

Failure to Ensure Call Bells Were Accessible to Residents

Cranberry Township, Pennsylvania Survey Completed on 01-31-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to reasonably accommodate residents’ call bell needs, as required by its own policy on accommodation of needs. Resident Council meeting minutes documented that all 19 residents present unanimously reported that staff do not leave their call bells within reach. During a subsequent resident group meeting, two of seven residents stated that call bells are not always left where they can reach them and that staff put the call bells where residents cannot access them, noting that this happens frequently. These resident reports indicate a pattern of staff inaction in consistently positioning call bells so residents can independently summon assistance.

In addition, surveyors reviewed the clinical record of one resident with diagnoses including hypertension, GERD, and multiple sclerosis, whose care plan directed staff to ensure the call light was within reach and to encourage its use for assistance. During observation, this resident was found lying in bed with the call bell clipped to the pillow beside the resident’s head. When asked how the call bell was activated, the resident explained an inability to move the arms and reliance on head movement to trigger the call bell. The resident attempted to move the head vigorously from side to side but could not reach the call bell and stated that even with such effort it could not be activated, and that the pillow needed to be moved to the left. When a nurse aide entered and repositioned the pillow, the resident was then able to activate the call light, and the aide confirmed the resident had been unable to activate it in the original position. The Nursing Home Administrator acknowledged that the facility failed to accommodate call bell needs for the residents identified in the council, group meeting, and observation.