Failure to Keep Call Light Within Resident’s Reach
Penalty
Summary
The facility failed to ensure a resident’s call light was placed within reach, as required by its policy that all residents have a call light in place at all times to alert nursing personnel to their needs. During an observation and interview in the resident’s room, the resident was lying in bed with the head of the bed elevated and stated that CNAs did not give them their call light. Later, while outside the room, the resident was heard repeatedly yelling for a CNA and stating they did not have a call button, continuing to call out for several minutes. A subsequent observation with a CNA in the room showed the resident still in bed with the head of bed elevated, and the call button looped to the bed rail but hanging behind the top right-hand side of the mattress, out of the resident’s reach. The CNA confirmed the resident could not reach the call light and acknowledged that the call light should be within easy reach for residents. A review of the facility’s “Call Light – Answering” policy, last reviewed on 4/25/14, indicated that the call light system is the only mechanism at the bedside for residents to alert nursing personnel to their needs, that each resident receives directions on its use and positioning upon admission, and that all residents will have a call light in place at all times. The observations and interviews showed that this policy was not followed for this resident, resulting in the resident not having ready access to the call light while in bed.
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