Failure to Supervise Resident Smoking and Enforce Smoking Policies
Penalty
Summary
A deficiency was identified when a resident, who had diagnoses including nontraumatic intracerebral hemorrhage, dysphagia, hypertension, major depressive disorder, hyperlipidemia, congestive heart failure, and diabetes mellitus, was observed smoking unsupervised inside the facility in the doorway leading to the courtyard. The resident was cognitively intact but required staff assistance for medication administration, set up with eating, oral hygiene, toilet use, and supervision with bathing. The resident's care plan specified that he was a supervised smoker, with smoking materials to be stored in a designated area and smoking only permitted in designated areas under supervision. However, the resident was able to obtain a cigarette and lighter and smoked inside the facility without supervision, outside of the scheduled smoking times. Staff interviews confirmed that the resident was not supposed to have access to smoking materials and that all smoking was to be supervised and conducted only in the designated courtyard area during scheduled times. The MDS nurse and DON both verified that the facility's policy required smoking items to be kept at the nurse's station and that residents should be supervised when smoking. The facility's smoking policy also prohibited smoking in all areas except the designated smoking area and required safety measures to be in place. Despite these policies, the resident was able to circumvent the rules, resulting in a failure to provide a safe environment and adequate supervision to prevent accidents related to smoking.