Provisions for signaling/call systems should include safeguards for residents who, due to dementia or other reasons, cannot or will not use the pull cords or phone to call for help.  These residents should be identified and monitored hourly during certain periods as is the requirement for facilities with fewer than 19 residents.  Recommend requiring new facilities and existing facilities that replace signaling systems to install technology that includes silent alarms or other passive signaling systems to alert staff when a resident with dementia needs assistance.  These types of considerations were included in the Mary Marshall facility, and should be in other facilities as well.