F0557

D

Failure to Maintain Resident Dignity During Supervised Smoking Break

Lampasas, Texas Survey Completed on 01-07-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure residents were treated with respect and dignity during a supervised smoking break. A male resident with hypertension, schizophrenia, a history of traumatic brain injury, and mildly impaired cognition (BIMS 12) and a female resident with anxiety disorder, vascular dementia, depression, and severely impaired cognition (BIMS 6) were observed at a smoke break along with other residents. The LVN supervising the smoke break controlled the cigarettes and lighter. When the LVN reached the male resident, she told him she did not have cigarettes for him because staff had not been to the store; he became visibly upset, with a pursed brow, frown, and looking away, but did not speak. Shortly afterward, the female resident attempted to share her cigarette with him. In response, the LVN spoke in a sharp and condescending tone, loudly saying, “No! No! Yall can't be sharing. nuh-uh, no ma'am!” audible to all residents and the surveyor. When the female resident questioned when the rule had changed, the LVN replied, “It's just policy you cannot share. It's been a thing for a while,” and confirmed “Uh huh 100%” when the resident asked if she was serious. The male resident then made an angry facial expression and left the smoking area.

The LVN further told the female resident, “No, ma'am, you cannot take that with you,” when she tried to pocket her unfinished cigarette, and held an ashtray out in front of her, after which the resident angrily threw the cigarette butt into the ashtray and left the area. In interviews, the male resident stated he was angry about what happened, felt he had been spoken to as a child, and that it made him feel “shitty,” adding that he was used to being spoken to that way at the facility. The female resident stated the LVN always spoke to them like that, had not reported it as a grievance because she thought it would make things worse, and believed the LVN did not like Black people and that this was why she spoke to them in that manner. She also stated she understood sharing a cigarette could be an infection control problem but had not known it was against the rules. The LVN reported she had been told residents could not share cigarettes due to infection control but could not recall who told her or any training on dignity or enforcing rules while maintaining dignity. Review of in-service records from October 2025 through January 2026 showed no specific in-service on treating residents with dignity and respect, and the facility’s policy on Rights of the Elderly stated residents have the right to be treated with dignity and respect for personal integrity without regard to race or other characteristics and to make their own choices regarding personal affairs, care, benefits, and services.