Failure to Enforce Smoking Policy for Cognitively Impaired Resident
Penalty
Summary
The facility failed to implement its smoking policy and procedure for a resident with significant cognitive impairment and behavioral issues. The resident, who had diagnoses including schizoaffective disorder, schizophrenia, and traumatic brain injury, was assessed as having moderately impaired cognition and was determined to be a danger to self or others while smoking. The resident's care plan indicated a risk for self-injury related to smoking and a tendency to hoard cigarettes, with interventions requiring staff to explain and enforce the facility's smoking policy. Despite these documented risks and interventions, the resident was found with two cigarettes in their possession in their room, which was not in accordance with the facility's policy that required nursing staff to maintain control of smoking materials for residents needing supervision. Interviews with staff revealed inconsistent practices regarding the handling of cigarettes, with a certified nurse assistant stating that residents were usually given one cigarette per day and could keep cigarettes in their rooms, while a licensed vocational nurse and the director of nursing confirmed that residents were not allowed to keep cigarettes or lighters. The facility's written policy specified that smoking materials for residents requiring supervision should be maintained by nursing staff. The failure to follow this policy resulted in the resident having unsupervised access to cigarettes, creating a potential fire hazard within the facility.