Failure to Ensure Resident Call Lights Were Accessible
Penalty
Summary
The facility failed to follow its call light policy requiring a functioning call light to be placed where it is accessible to the resident, resulting in multiple residents not having call lights within reach. During observation on 2/13/26 at 9:45 AM, one resident was heard shouting for help from his room and reported being uncomfortable in a reclining chair after returning from dialysis at 5:00 AM and wanting to go back to bed; his call light cord was found by the DON wedged between the wall and a folded floor mat behind the head of the bed, and he stated he could not find it. Later that morning, another resident lying in bed had a call light cord observed dangling on a wheelchair positioned at the side of the bed and stated not knowing where the call light was. A third resident sitting in a wheelchair next to her bed had a call light cord located behind the wheelchair and not within reach, and also stated not knowing where the call light was. A fourth resident sitting in a wheelchair next to her roommate’s bed similarly stated she did not know where her call light cord was, and her call light was observed not to be within reach. These observations and resident interviews showed that four residents did not have accessible call lights as required by the facility’s policy. The deficiency centers on the inaccessibility of call light cords for these residents, as evidenced by their inability to locate or reach the call lights when they needed assistance, and the physical placement of the cords behind furniture or on equipment rather than within the residents’ immediate reach.
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