Failure to Update Smoking Assessment and Post Oxygen Signage
Penalty
Summary
The facility failed to maintain an environment free from accident hazards and did not provide adequate supervision to prevent accidents for two residents. One resident, who was initially assessed as a nonsmoker upon admission, was observed smoking unsupervised in the designated smoking area with cigarettes and lighters in her possession. The resident's smoking risk assessment had not been updated to reflect her current smoking status, and staff responsible for supervision left the area, leaving her unattended. Facility policy required smoking assessments to be updated at admission, quarterly, annually, and as needed, but this was not followed. Additionally, another resident receiving oxygen therapy did not have an 'oxygen in use' sign posted at the entrance to their room, as required by facility policy. Observations confirmed the resident was on oxygen via nasal cannula, but signage was missing, which staff acknowledged was necessary to alert others to the presence of oxygen. The Infection Prevention nurse confirmed the lack of signage and stated that the expectation was for licensed nurses to ensure the sign was posted, but this was not done. The facility's policy on oxygen therapy specified that 'oxygen in use' signs should be placed both inside and outside the room.