Unsecured Smoking Materials and Inadequate Lighting in Smoking Area
Penalty
Summary
The deficiency involves the facility’s failure to secure cigarettes and complete a smoking assessment for one resident, and failure to maintain adequate lighting in the smoking area and access pathway. One cognitively intact resident with current tobacco use had cigarettes stored unsecured in the top drawer of the bedside cabinet. The resident stated they kept their cigarettes in the drawer, and the cigarettes were later collected by an LPN, who stated they should have been locked in the treatment cart labeled with the resident’s name. The DON reported that residents were expected to give staff their cigarettes when purchased so they could be locked in the treatment cart. The same resident’s smoking assessment, dated several days prior to the MDS, was incomplete, with blanks under the sections for medications, resident behaviors, and nursing assessment of smoking safety. A Resident Care Manager/RN confirmed that the smoking assessment was not complete and stated they would need to reevaluate the resident. These omissions meant that the resident’s smoking-related risks and safety needs were not fully documented or assessed as required by the facility’s process. The facility also failed to provide adequate lighting for residents using the designated smoking area and the sidewalk leading to it. Residents accessed the smoking area by exiting through the dining room door and proceeding along a concrete area and then a sidewalk with a small S-curve, where there were 2–6-inch drop-offs or ruts between the sidewalk edge and adjacent planters or ground, with visible wheel tracks in the mud. Staff who supervised smoking and multiple residents reported that management had stopped turning on the flood lights after dark due to concerns about residents smoking marijuana and a whiskey bottle found near the area, but residents continued to use the smoking area in the dark. One resident reported falling while walking back from the smoking area when it was “pitch black,” and other residents and staff described the area as dangerous due to the narrow sidewalk, uneven surfaces, and lack of lighting. Observations confirmed that the string of flood lights along the fence was the sole effective light source when on, that solar lights provided only a faint glow, and that ruts along the sidewalk had trapped residents’ electric wheelchairs, sometimes requiring assistance to get back onto the path.
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