Failure to Secure Smoking Materials and Provide Supervision for Residents Who Smoke
Penalty
Summary
Multiple residents with a history of smoking were found to have unsupervised access to cigarettes and lighters, contrary to the facility’s smoking policy and individualized care plans. One resident, with diagnoses including anxiety and bipolar disorder, was observed to keep cigarettes and a lighter in their possession, despite documentation indicating the need for supervised smoking and that all smoking materials should be stored securely by staff. Staff members, including a CNA, LVN, AD, DON, and ADM, were unaware that this resident had these items, and the resident reported obtaining them from a family member during visitation. The facility’s policy required all smoking materials to be locked at the nurse’s station, but this was not followed. Another resident, with heart failure and a pacemaker, also kept cigarettes and a lighter at their bedside and smoked on the patio without supervision. The care plan and smoking evaluation for this resident specified the need for supervised smoking and secure storage of smoking materials. The DON and ADM were not aware that the resident had these items, and the items were only retrieved after the issue was discovered. The facility’s policy, as stated by the DON, did not allow residents to keep smoking materials in their possession due to fire risk. A third resident, with anxiety disorder, palliative care needs, and severely impaired cognition, was found to have a lighter and cigarettes in their pocket. This resident was able to access the smoking patio independently by using a pin code, which staff stated should only be known by designated personnel to ensure supervision. Staff interviews confirmed that the resident could go to the patio and smoke unsupervised, in violation of the care plan and facility policy. The facility’s written policy required all smoking materials to be retained by nursing staff and for residents to be supervised while smoking, but these procedures were not consistently implemented.