Failure to Maintain Functional Nurse Call System in Resident Rooms and Bathrooms
Penalty
Summary
The deficiency involves the facility’s failure to maintain a properly functioning nurse call system in multiple resident rooms, including bathrooms and bathing areas, and to ensure that call lights were operational and able to alert staff at the nurse’s station. During observation, the call light panel at the nurse’s station showed active call lights for several rooms, but the corresponding call lights did not ring or illuminate in the rooms or hallway light domes. In one room, the call light cord was found disconnected and lying on the resident’s bed, and the wall plate for the call light was taped to the wall and loose. When the LVN attempted to plug the call light back in, it would not stay in the socket and slipped out. Staff reported that the resident in that room was confused, did not use the call light, and that the resident’s son used the call light when present. Further observations and interviews showed that dual call light systems in two rooms did not activate in the rooms or on the hallway light domes when tested. The Director of Support Services acknowledged that the wall plate was loose and that nursing staff should have submitted a work order, but there was no indication that such a work order had been made. A CNA confirmed that a confused resident had pulled the call light off the wall and stored it in a nightstand drawer, and that the wall plate had been taped but she was unaware of any work order and had not noticed that the call lights showing on the panel were not ringing. The Director of Support Services stated he conducted call light tests every two weeks but was unable to provide any documentation of these tests when requested, and later stated that one of the dual call light cords was not working, which explained why the dome light and nurse’s station alarm did not activate. The Administrator reported that corporate staff had informed her there was no policy and procedure on call lights.
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