Staff Provided Cannabis to Residents, Creating Accident Hazard
Penalty
Summary
The facility failed to ensure a safe environment free from accident hazards when an Activity Assistant (AA) provided cannabis products, including edibles and a joint, to two residents. The incident was reported by the residents to various staff members, including a Licensed Nurse (LN), a Certified Nursing Assistant (CNA), and the Social Services Director (SSD). Both residents admitted to voluntarily receiving and consuming the substances from the AA, and urine lab tests confirmed the presence of cannabinoids in their systems. One of the residents involved had a medical history that included hypertension, chronic obstructive pulmonary disease (COPD), and diabetes mellitus with diabetic neuropathy. Observations following the incident noted that this resident was acting differently than usual, including talking slower and laughing more. The resident reported unmanaged pain as a reason for accepting the cannabis edible and expressed concern about being penalized for honesty but denied feeling unsafe. The other resident had a history of falls, degenerative disease of the nervous system, and hypertensive heart failure. This resident also reported receiving cannabis and tobacco products from the AA and described the use as voluntary and recreational, denying coercion or feeling unsafe. Interviews with staff and review of facility documentation confirmed that the AA's actions were not in accordance with facility policy, which strictly prohibits the sale, use, possession, or distribution of illegal substances, including marijuana, on facility property. The AA's job description did not include providing such substances, and the employee handbook emphasized maintaining a drug-free workplace. The facility acknowledged that the residents' safety was placed at risk due to the AA's actions, particularly regarding potential drug interactions, increased risk of falls, and impaired cognition.