Failure to Develop and Implement Smoking-Related Care Plans
Penalty
Summary
The facility failed to develop and implement care plans addressing the smoking needs of two residents who required substantial or maximal assistance with activities of daily living and had intact cognition. Both residents had documented assessments indicating the need for specific safety measures while smoking, such as the use of a smoking apron and, for one resident, a cigarette extension. Despite these documented needs, there were no care plans created to guide staff in providing the necessary interventions to ensure the residents' safety during smoking activities. Observations revealed that both residents were seen smoking without the required safety equipment, and staff confirmed that no care plans were in place for smoking-related risks. Interviews with nursing staff and the DON confirmed the absence of care plans and acknowledged that care plans are intended to guide staff in maintaining resident safety. The facility's own policy required comprehensive, person-centered care plans with measurable objectives and timetables, but this was not followed for the two residents in question.