Failure to Provide Accessible Call Light for Resident With Contracted Hands
Penalty
Summary
The deficiency involves the facility’s failure to reasonably accommodate a resident’s needs and preferences regarding use of the call light system. The resident was an older male with multiple diagnoses including end stage renal disease, altered mental status, bipolar disorder, metabolic encephalopathy, thrombocytopenia, congestive heart failure, restlessness and agitation, dysphagia, muscle weakness, abnormal posture, and cognitive communication deficit. His admission MDS showed a BIMS score of 06, indicating severe cognitive impairment, and documented no limitations in upper extremity range of motion. His care plan identified an ADL self-care performance deficit and risk for falls, with interventions directing staff to ensure the call light was within reach and to encourage him to use it for assistance. On multiple observations, the resident was heard repeatedly yelling “Nurse! Nurse!” from his room instead of using the call button. During one observation, the ADON responded after the second episode of yelling and found the resident with a standard call button within reach. Both of his hands were contracted. In a subsequent interview and observation, the resident stated he knew how to press the call button but had great difficulty doing so because of his hands. He demonstrated that he could pick up the call button with his right hand and use a finger on his left hand to press it, but this required extreme effort and concentration. Additional observations showed the resident continuing to yell for assistance, with staff responding to his calls from the hallway. Staff interviews confirmed that the resident was unable to effectively use the standard call button due to his contracted hands. A CNA who regularly worked on the resident’s hall stated that he could not use the call button and that she and another aide had notified the nurse on the hall that he needed a flat call button to accommodate his condition. Another observation documented a CNA asking an LVN to obtain a flat call button so the resident could more easily use it and stop yelling into the hall. However, a later observation showed that the resident still had the standard call button and no flat button, and he stated he would have liked and used a flat call button if he had one he could more easily press. The facility’s Resident Rights policy stated that residents have the right to reside and receive services with reasonable accommodation of their needs and preferences, which was not implemented for this resident’s call light needs.
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