Failure to Enforce Smoking Safety Policies and Interventions
Penalty
Summary
The facility failed to ensure that residents who smoked were properly assessed and that safety interventions were followed, as required by their own smoking policy. Two residents, both moderately cognitively impaired and with significant physical or cognitive limitations, were not managed according to their Smoking Evaluations. One resident, who required a smoking apron, was observed smoking without it, and another resident, who had been deemed not safe to smoke, was also observed smoking. Additionally, residents were not restricted to the designated smoking area, with several observed smoking along the sidewalks outside the designated structure. Observations revealed that residents were flicking ashes onto the ground and pocketing cigarette butts, and that cigarette smoke was drifting into rooms with open windows, affecting other residents. Staff interviews confirmed that required interventions based on Smoking Evaluations were not being followed, and that facility leadership was unaware of these lapses. The facility's policy required quarterly smoking evaluations and adherence to safety interventions, but these were not consistently implemented or monitored.