Failure to Implement Smoking Safety Procedures and Use of Approved Ashtrays
Penalty
Summary
The facility failed to implement its established procedures for smoking safety and the safety of smoking areas, as evidenced by the case of one resident who smokes. According to the facility's Smoking/Vaping Policy, residents who smoke are to have an initial smoking assessment upon admission, with safety considerations such as the need for assistance, supervision, and the use of special equipment. Matches and lighters are required to be kept at the nurse's station, and only approved, noncombustible ash containers are to be used in designated smoking areas. However, observations revealed that the resident was using a plastic cup as an ashtray while smoking in the designated area, and had a blue lighter stored in her cigarette pack in her room, contrary to facility policy. The resident reported difficulty using the facility-provided ash receptacles and therefore used a plastic cup instead. Further review of the resident's clinical record showed she had a history of rheumatoid arthritis and mononeuropathy, was assessed as cognitively intact, and was considered safe to smoke independently. Despite this, the resident's shirt was observed to have multiple small holes, which she identified as old burn marks. Facility leadership, including the DON and NHA, were unable to provide documentation that the required protocols for securing lighters and matches were followed, nor could they confirm that the plastic cup used as an ashtray was an approved receptacle. Additionally, there was no evidence that staff had previously identified or addressed the burn holes in the resident's clothing until prompted by surveyors.