Green Lea Senior Living: Call Light Failures Risk Falls - MN
That was 4:05 p.m. on October 10 at Green Lea Senior Living. A nursing assistant arrived five minutes later and acknowledged the call light should have been within the resident's reach. She said he tended to get agitated when it wasn't accessible, and that he might try to transfer himself without help if he couldn't call for staff.
His care plan said exactly that. It identified him as a fall risk due to poor balance and unawareness of safety hazards, and listed a call light within reach as an intervention. He had severe cognitive impairment and needed extensive assistance for all transfers.
Four days later, a second resident was found in nearly identical circumstances.
On October 14 at 3:58 p.m., an inspector walked past a room and was waved in by a woman sitting in a recliner. She had Alzheimer's disease, severe cognitive impairment, and needed maximum assistance to transfer. Her call light was on the floor next to her left foot, unreachable from where she sat. A cup and pieces of chocolate were also on the floor near her feet. She told the inspector she could not find her button.
A nursing assistant entered at 4:06 p.m. and said the call light was not where it should be and needed to be placed within the resident's reach so she could ask for help. Her care plan, like her neighbor's, listed a call light within reach as a fall prevention measure.
The director of nursing, interviewed on October 17, said all residents should always have call lights within reach and that her expectation was for all staff to place them appropriately.
The facility's own call light policy, undated, states that staff will ensure the call light is within reach of the resident and secured as needed.
Both residents were left to flag down strangers instead.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Green Lea Senior Living from 2025-10-17 including all violations, facility responses, and corrective action plans.
Additional Resources
Data source: Official federal inspection data from the Centers for Medicare & Medicaid Services (CMS).
Editorial process: AI-synthesized regulatory data, reviewed for accuracy by our editorial team.
Professional review: All content reviewed by Christopher F. Nesbitt, Sr., NH EMT & BU-trained Paralegal.
Last verified: June 24, 2026 · Our methodology
Green Lea Senior Living in MABEL, MN was cited for violations during a health inspection on October 17, 2025.
on October 10 at Green Lea Senior Living.
Health inspections identify deficiencies that facilities must correct. Violations range from minor documentation issues to serious safety concerns. Review the full report below for specific details and facility response.