Failure to Ensure Call Light Accessibility for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to reasonably accommodate a resident’s needs and preferences by not ensuring her call light was within reach while in bed. The resident was an adult female with hemiplegia and hemiparesis following a cerebral infarction affecting the left non-dominant side, aphasia, dysphasia, anoxic brain damage, chronic pain, anxiety disorder, and major depressive disorder. Her significant change MDS showed a BIMS score of 14, indicating intact cognition, and Section GG documented that she required maximal assistance with most ADLs. Her care plan identified an ADL self-care performance deficit related to paraplegia/post-CVA affecting the left side, and indicated she could move up in bed, turn side to side, and sit on the side of the bed with cueing and assistance from one to two staff. During observation, the resident was lying in bed, using her electronic tablet to communicate due to aphasia, and was unable to move her left arm but could use her right arm to reach nearby items. She communicated via the tablet that she often could not get help when needed because her call light was usually not within reach, and when her door was closed staff could not see her waving for help. She reported that staff generally came in about every two hours, but she sometimes needed help sooner, especially when essential items were not left within reach on her bedside table, which caused her frustration and discomfort. Observation of the room at that time showed the call light cord coming from the wall on the left side and tucked behind the bed frame, leaving her without access to the call light to directly notify nurses. Staff interviews confirmed the resident’s limited mobility and reliance on the call light and tablet for assistance. A CNA stated the resident could use her right arm but could not fully turn without assistance and that it was important for the call light to be clipped near the resident’s chest or on the bed sheet due to her limited mobility. The CNA recalled the call light being within reach earlier when passing the breakfast tray but acknowledged that after repositioning the resident she may have moved the call light away and forgotten to clip it back within reach. An RN stated call lights should always be within residents’ reach and never tucked behind the bed and was not aware that this resident’s call light was behind the bed. The DON stated the resident was physically dependent on staff on one side, communicated primarily through her tablet and other signals, and that it was protocol for CNAs to ensure call lights were within reach before leaving rooms. The resident’s representative reported ongoing concerns that staff sometimes forgot about the resident, that the call light was often out of reach, and that this concern had been raised with the facility several times. The facility’s Resident Rights policy stated that residents have rights including communication with and access to people and services inside and outside the facility.
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