Failure to Control Resident Smoking Materials and Maintain Accurate Smoking Assessments
Penalty
Summary
The deficiency involves the facility’s failure to ensure a safe environment and adequate supervision related to resident smoking and smoking materials. During observation and interview, one resident was found sitting in bed with a sitter present and stated he was a smoker who kept his cigarettes and lighter in his jacket by the bedside. He produced a pack of cigarettes and a lighter from his jacket pocket and stated he only smoked on the smoking patio. Another resident, observed alert and oriented in a wheelchair at bedside, stated she was a smoker and kept her smoking materials in her nightstand drawer. She removed a lighter and a pack of cigarettes from the top nightstand drawer and also stated she only smoked on the smoking patio. When interviewed, the LVN stated residents were not allowed to have smoking materials and that only activities staff were supposed to have residents’ smoking materials. During this interview, the first resident again produced his cigarettes and lighter, and the LVN confirmed he should not have smoking materials with him. Record review for this resident showed a readmission with diagnoses including end stage renal disease, nicotine dependence, and an above-knee amputation, and a history and physical indicating he had capacity to make decisions. However, his smoking assessment documented him as a non-smoker and did not reflect his current smoking status as a smoker. There was no documented smoking assessment reflecting his current status until the concurrent observation and interview on the survey date, confirming he had been allowed to smoke without a valid smoking assessment and without supervision. For the second resident, record review showed admission diagnoses including COPD, diabetes mellitus, and major depressive disorder, with a history and physical indicating fluctuating capacity to understand and make decisions. Her quarterly smoking assessment documented that she was a smoker, a safe smoker, and independent. Her care plan stated she smoked cigarettes and was independent, with a goal that she would smoke safely with supervision, and interventions specifying that activity staff would keep all smoking materials in the smoking cart at all times, give one cigarette and light it for her, and supervise all residents. The DON stated that facility process required smoking assessments on admission and quarterly, that independent smokers could keep cigarettes but not lighters, and that residents were not allowed to have lighters. The DON acknowledged that the first resident’s assessment did not reflect his current smoking status and that he should not be smoking without an assessment or supervision, and that the second resident, although assessed as an independent safe smoker, should not have had a lighter at bedside under facility policy.
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