Failure to Complete and Document Smoking Assessment and Safety Measures
Penalty
Summary
The facility failed to ensure a thorough and up-to-date smoking assessment was completed for a resident who wished to smoke. The resident, who had intact cognition but required assistance with all activities of daily living, had multiple diagnoses including COPD, non-Alzheimer's dementia, anxiety disorder, depression, schizophrenia, and nicotine dependence. The resident's care plan indicated she was an independent smoker and required the use of a smoking apron when smoking, in accordance with facility policy. However, the most recent smoking assessment did not document the use or assessment of the smoking apron, and there was no evidence that the assessment had been updated as required. Observations showed staff inconsistently reminded the resident to use the apron, and interviews with staff revealed confusion and inconsistency regarding the resident's use of the smoking apron and the frequency of required smoking assessments. Further review of facility policy indicated that residents identified as smokers should be assessed upon admission, quarterly, annually, and as needed for significant changes or incidents. The policy also required that residents needing a smoking apron, as determined by the assessment, must always wear one while smoking. Despite this, the last documented smoking assessment was not current, and it did not address the use of the smoking apron. Multiple staff interviews confirmed that the required assessments were not completed as per policy, and the use of the smoking apron was not consistently enforced or documented.