F0725

E

Failure to Respond to Resident Call Lights in a Timely Manner

Cedar Rapids, Iowa Survey Completed on 03-10-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to consistently respond to resident call lights in a timely manner, despite the requirement to provide sufficient nursing staff each day and have a licensed nurse in charge on each shift. Record review showed that three residents with intact cognitive status reported prolonged call light response times. One resident, seated in the dining room with a walker nearby, stated that call light responses often took more than fifteen minutes and that she also activated the call light for her roommate, who was unable to call for assistance independently. Another resident, who required the assistance of two staff members for transfers and toileting, reported that staff failed to answer his call light in a timely manner at least once a day on any shift, and that he had personally timed responses taking up to an hour, which resulted in episodes of incontinence.

A third resident, observed in a recliner with oxygen via nasal cannula and a walker nearby, reported that staff were slow to respond to his call light, with response times sometimes exceeding thirty minutes and up to an hour based on his own timing. He also reported that staff at times entered his room in response to the call light, turned the light off, left without providing the requested assistance, and did not return. This resident required staff assistance to ambulate when feeling unsteady. Resident Council meeting notes documented that call lights taking too long had been raised as an ongoing concern under Old Business. During an interview, the DON and Administrator acknowledged that when Resident Council reports identify call light concerns, the facility addresses them through audits and staff education and reviews the concern at subsequent Resident Council meetings.