Failure to Provide Timely ADL Assistance and Call Light Response
Penalty
Summary
The deficiency involves the facility’s failure to provide timely assistance with activities of daily living (ADLs) and to respond promptly to call lights for three residents who required staff help. Surveyors observed a resident’s call light illuminated while an LVN, PT, and CNAs walked past the room without responding. Facility policy on call lights stated they were to be answered within a reasonable time, and the DON, LVN, and CNA interviewed all stated that all staff were responsible for answering call lights as soon as they were activated. One resident with diabetes, gait abnormalities, and coordination problems required substantial to maximal assistance with lower body dressing, toileting hygiene, transfers, and bed mobility, and was cognitively intact and able to communicate needs. This resident reported that on unspecified dates it sometimes took 30 minutes to one hour for night-shift nurses to respond to call lights for assistance with bathroom use and obtaining water. Another resident with diabetes, gait abnormalities, and a right below-knee amputation, who required supervision or touching assistance for ADLs and was frequently incontinent of urine and occasionally incontinent of bowel, stated that it sometimes took one hour for night-shift nurses to respond to call lights for incontinence care. A third resident with COPD, diabetes, gait abnormalities, and muscle weakness was totally dependent on staff for toileting, showering, and lower body dressing, was always incontinent of bowel and bladder, and was care planned for nursing assistance with toilet use. During observation and interview, this resident was seated in a chair with the call light on, stating a need to urinate. The ADM and CNA told the resident to urinate in the incontinence brief, and the resident reported that staff typically took about 30 minutes to respond to call lights, that she considered herself continent, that staff told her to urinate in her brief, and that she had not been provided a bedside commode and did not like being left wet while waiting to be changed. CNA and LVN interviews confirmed that telling the resident to urinate in the brief instead of offering a bedpan or bedside commode was not appropriate and that leaving residents wet or with unanswered call lights for extended periods was inconsistent with facility expectations and policies for perineal care and call light response.
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