Failure to Prevent Accident Hazards and Inadequate Supervision of Smoking and Sharp Objects
Penalty
Summary
The facility failed to ensure a safe environment free from accident hazards and did not provide adequate supervision to prevent accidents for multiple residents. One resident, who had a history of seizures and required assistance with daily activities, sustained a cigarette burn on his thigh after dropping a cigarette while smoking. Documentation showed that he was assessed as an unsafe smoker and required supervision and a smoking apron, but on observation, he was not wearing the apron while smoking under supervision. There was no evidence that the incident was reported to the state, and staff interviews revealed a lack of awareness and follow-up regarding the incident and required interventions. Another resident, diagnosed with multiple sclerosis and assessed as an unsafe smoker, was allowed to sign out and smoke in an unsafe area without supervision and kept cigarettes, a vape, and a lighter in his possession. Staff interviews indicated confusion about the resident's supervision requirements and the facility's smoking policy, with some staff believing the resident could make his own decisions despite being deemed unsafe. Observations confirmed that the resident was unsupervised while smoking and vaping, and staff were unaware of the full extent of his access to smoking materials. Additional deficiencies included a resident assessed as a safe smoker who was observed smoking on the side of a residential street after signing out, and another resident with severe cognitive impairment who also signed herself out to smoke in an unsafe area. Furthermore, a resident with moderate cognitive impairment and dependence on staff for personal hygiene was found to have seven disposable razors stored insecurely in his room, accessible on top of his mini refrigerator. Staff acknowledged that razors should not be left in resident rooms and should be disposed of in sharps containers after use, but the razors remained accessible for an extended period.
Removal Plan
- Residents #22, #48, and #32 will be supervised when in an unsafe area. The physician was notified of both the smoking and residents leaving safe supervised area.
- All smoking assessments were audited for accuracy and care plan updated as indicated. Residents #22, #48, and #32 were reassessed and evaluation determined they are safe smokers and able to vape safely. Resident #25 was reassessed and evaluation determined he is an unsafe smoker.
- All smokers were reassessed, and changes made to safe or unsafe smoking, including vaping as indicated.
- Assessments completed by Corporate Clinical Specialist and Corporate Case Mix. Residents assessed to be unsafe will be supervised and smoking supplies will be held at the nurse's station. Residents assessed to be a safe smoker will be able to smoke unsupervised at their leisure in the designated smoking area.
- An emergency care plan meeting was conducted with residents (#22, #48, #32, and #25) regarding safe supervision and smoking policy, to include vaping. Residents #22, #48 and #32 were informed they can smoke only in the smoking area of the facility. Resident #25 was informed that he remains an unsafe smoker and must be supervised. All smoking residents were educated in regards to the smoking area of the facility and informed that location is the only place they can smoke. Care plans updated as indicated to include education regarding safety plan and pedestrian safety.
- Ombudsman notified of the incident with Resident #22, #48, and #32 smoking unsupervised in an unsafe area. Informed of Resident #25 incident of cigarette burn.
- Medical Director notified of the incident with Resident #22, #48, and #32 smoking unsupervised in an unsafe area. Informed of Resident #25 incident of cigarette burn.
- Corporate Clinical Specialist in-serviced Administrator and ADON regarding Accident/Hazard Supervision, specifically in regard to safe smoking policy, smoking assessment accuracy, designated smoking areas, and remaining in safe supervised area. Competency verified by quiz.
- Facility Administrator and ADON in-serviced all staff regarding Accident/Hazard Supervision, specifically in regard to safe smoking policy, designated smoking areas, and remaining in safe supervised area. Competency verified by quiz. Staff will not be allowed to work until completion.
- Corporate Clinical Specialist in-serviced staff on residents that are safe smokers and those that are not, and how to find that information.
- Corporate Clinical Specialist, or designee, in-serviced licensed nurses on completing smoking risk assessment accurately as related to current health concerns/conditions, resident capabilities, and resident smoking material preference (cigarettes and/or electronic cigarettes). In-service included that Licensed Nurses are responsible for completing the smoking assessments upon admission, change of condition, and quarterly.
- The above training regarding Accident/Hazard Supervision, specifically in regard to safe smoking and safe supervision will be implemented into new hire orientation.
- To monitor compliance, residents will be monitored by the DON/designee through observations and communication with staff daily and monthly.
- DON/designee will review smoking assessments weekly and monthly.
- The QA committee will meet weekly to review compliance with the plan of action. If no further concerns are noted, the facility will continue to be monitored as per the routine facility QA committee.