Failure to Supervise Resident During Smoking Activities
Penalty
Summary
A deficiency occurred when the facility failed to ensure the safety of a resident while smoking. The resident, who had multiple diagnoses including anxiety disorder, major depressive disorder, chronic pain syndrome, paraplegia, and nicotine dependence, was assessed as a safe smoker and allowed to keep her cigarettes and lighter in her possession. Observations showed the resident smoking outside in the courtyard on multiple occasions without staff supervision, despite her care plan indicating she was at high risk for falls and required substantial to maximal assistance for activities of daily living. The resident reported that staff did not check on her while she was outside smoking, and she was observed with other residents, with no staff present, for extended periods. During one observation, another resident accessed the first resident's bag and took a cigarette, and the resident was seen crying out for help with shaky hands while holding a lit cigarette. No staff responded to her calls for help, and she remained unsupervised. The facility's policy required residents to be reassessed for safe smoking if there was a decline in condition or cognition and stated that smoking supplies should not be left accessible to other residents. The DON confirmed that residents exhibiting distress or changes in condition while smoking should be reassessed and that smoking materials should not be left out. Despite these policies, the resident was left unsupervised with smoking materials accessible to others, and her distress went unaddressed by staff.