Failure to Assess and Supervise Resident Smoking, Leading to Immediate Jeopardy
Penalty
Summary
The facility failed to consistently and accurately assess residents' smoking abilities and implement safety interventions to prevent smoking-related injuries for three residents. Despite having a policy that prohibited smoking on facility grounds and required staff to secure smoking materials found with residents, the facility did not ensure that these procedures were followed. Staff were often unaware of which residents smoked, and there was a lack of clear documentation and care planning regarding residents' smoking status, supervision needs, and the storage of smoking materials. One resident with Parkinson's disease and diabetes was observed smoking unsupervised in the facility's patio area, near a propane tank, and without access to proper safety equipment such as ashtrays or fire blankets. This resident had a history of fluctuating consciousness and required assistance with mobility, yet was able to keep cigarettes and a lighter in their possession and smoke multiple times a day. The care plan for this resident did not include specific interventions to address their inability to manage smoking supplies safely, nor did it document where smoking materials were kept. Additionally, although a nicotine patch was recommended as part of a smoking cessation plan, it was not provided as indicated. Another resident with COPD and a history of tobacco abuse continued to smoke on facility property and in their room, even after being educated about the non-smoking policy and offered nicotine patches, which they refused. This resident set off the fire alarm by smoking in their bathroom and repeatedly refused to relinquish smoking materials, resulting in the need for increased supervision. A third resident with severe cognitive impairment had a history of daily smoking, but the facility's assessment failed to identify their tobacco use, and staff did not discuss smoking or the facility's policy with them. These failures led to unsafe conditions and represented an immediate jeopardy to resident health and safety.
Removal Plan
- Placed Resident 73 on one-to-one surveillance.
- Secured Resident 73's smoking paraphernalia.
- Re-assessed Resident 73's ability to smoke.
- Revised Resident 73's care plan to show the level of assistance and supervision required to smoke safely.
- Closed access to unsupervised patio areas.
- Added a fire blanket and an outdoor ashtray to the designated smoking area.
- Interviewed other residents and staff to identify other residents who smoked.
- Completed smoking safety evaluations of all residents in the facility and for any residents identified as a smoker/tobacco user.
- Developed or revised care plans for residents identified as smokers/tobacco users to show individualized interventions and supervision levels related to smoking preference.
- Completed a facility-wide sweep to remove unauthorized smoking materials.
- Notified residents of the smoking policy.
- Educated staff on the smoking policy, and identifying, managing, and reporting unsafe smoking behaviors.