Failure to Supervise and Secure Smoking Materials for Residents
Penalty
Summary
Surveyors identified that the facility failed to ensure a safe environment free from accident hazards and did not provide adequate supervision to prevent accidents related to resident smoking. For three residents reviewed for smoking, there were multiple failures including untimely completion of smoking assessments, lack of supervision during smoking, and failure to secure smoking materials as required by the residents' care plans and facility policy. Observations showed residents smoking unsupervised on facility property, possessing lighters and cigarettes despite policies prohibiting such items, and sharing smoking materials with other residents. One resident with end stage heart failure, asthma, and a left leg amputation was observed smoking outside the facility unsupervised on several occasions. Although the resident's care plan required that smoking materials be secured by nursing staff and that the resident not possess such items, the resident was found with a lighter in their possession and admitted to purchasing and keeping smoking materials. Interviews with staff revealed confusion and lack of clarity regarding who was responsible for securing smoking materials, with both nursing and front desk staff denying responsibility. Smoking assessments for this resident were not completed quarterly as required, and the resident was observed repeatedly smoking on facility property without supervision. Two other residents with histories of smoking and medical conditions such as diabetes, falls, osteoarthritis, substance abuse, and acute kidney failure were also found to have incomplete or delayed smoking assessments. One resident did not have a smoking assessment completed upon admission, and another had only one assessment completed months after admission. Both residents were observed smoking on facility property, sometimes sharing lighters, and staff interviews indicated a lack of awareness about the residents' smoking status and the location of their smoking materials. Facility policy required completion of smoking assessments on admission and securing of smoking materials, but these procedures were not consistently followed.