Failure to Honor Resident Rights to Outdoor Access and Self-Determination in Smoking Practices
Penalty
Summary
The facility failed to honor residents' rights to a dignified existence, self-determination, and communication by restricting access to outdoor areas and limiting smoking opportunities for residents, including those who were cognitively intact and assessed as safe to smoke without supervision. Facility policy required that residents be informed of smoking policies and that their preferences and abilities be assessed, but in practice, residents were only permitted to smoke three times daily for twenty minutes each, with a maximum of two cigarettes per session. These sessions were strictly supervised by activity staff, and the outdoor patio area was locked outside of these designated times, preventing residents from accessing the area at their leisure. Multiple residents, both smokers and non-smokers, expressed dissatisfaction with these restrictions. Cognitively intact residents who were assessed as not requiring supervision for smoking reported that they would like more frequent access to smoke breaks, the ability to smoke more cigarettes per session, and the opportunity to smoke after dinner or before bed. Non-smoking residents were also limited in their access to the outdoor patio, only being allowed outside twice daily during scheduled activities, with no option to go out at other times. Staff interviews confirmed that the patio was kept locked and that residents could only go outside when accompanied by staff, citing safety concerns such as the risk of falls. Review of facility records and interviews revealed that these restrictions were not individualized based on resident assessments or preferences, but rather applied uniformly to all residents regardless of their cognitive status or ability to safely access the outdoor area. The activity calendar did not include any outdoor activities, further limiting residents' opportunities for outdoor access. The facility's actions were inconsistent with its own policies and regulatory requirements to promote resident rights, dignity, and quality of life.