Failure to Provide Assigned Supervision for Grandfathered Supervised Smoker
Penalty
Summary
The deficiency involves the facility’s failure to follow its Smoke Free Policy and care plan requirements for a grandfathered supervised smoker, resulting in a lack of assigned staff supervision during designated smoking times. The facility’s policy states that when a grandfathered resident is identified as needing supervision, a partner must be physically present in the designated smoking area for all supervised smokers. The resident’s EHR documented diagnoses including hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side, unspecified lack of coordination, hypertension, vascular dementia, and bilateral age-related nuclear cataracts. The resident was identified as a current every day smoker, with a quarterly MDS showing a BIMS score of 12 (moderate cognitive impairment), and the care plan documented that he was a supervised smoker at risk for smoking-related injury, requiring staff supervision during smoking at designated times. Despite these documented needs and the facility’s policy, review of CNA assignment sheets for multiple dates showed no medical staff assigned to supervise smoke breaks. Interviews with nursing staff and the staffing coordinator confirmed that no specific individual was designated for the resident’s smoke breaks and that it was generally assumed the CNA on the 100 hall would manage this responsibility. Observations on two separate days showed the resident waiting in the lobby at scheduled smoking times without staff arriving to supervise, leading him to return to his room and report that he frequently missed his smoke breaks. Staff interviews further revealed confusion and inconsistency about who was responsible for supervising smoking, including reference to a prior assignment book that may no longer be in use, demonstrating that the facility did not implement its own procedures for supervised smoking for this resident.
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