F0689

K

Failure to Ensure Safe, Supervised Smoking for Residents With Impairments and Oxygen Use

Smyrna, Delaware Survey Completed on 01-09-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to ensure safe smoking practices and adequate supervision for multiple residents who smoked, despite identified physical impairments and safety risks. Several residents were assessed as having upper extremity limitations, balance problems, or a history of unsafe smoking behaviors, yet were allowed to keep cigarettes and lighters and to smoke without direct supervision. The facility’s own smoking safety assessments and care plans documented that certain residents had impaired range of motion, poor vision, difficulty safely handling or extinguishing cigarettes, and a pattern of burning clothing or dropping ashes, but these findings were not consistently translated into supervised smoking or restricted access to smoking materials.

One resident with quadriplegia and bilateral upper extremity impairment was care planned as preferring to keep his lighter and to smoke at his leisure, and he declined to wear a smoking apron. Staff interviews confirmed that this resident kept his cigarettes and lighter in a cross‑body bag and that staff would transport him to the front smoking area and then leave him to smoke alone. Observations showed the resident, with severely contracted fingers and limited arm movement, independently retrieving and lighting a cigarette while staff present nearby were not actively supervising and were unaware of the availability of a smoking blanket. The front smoking area contained buckets and a large metal ashtray, but there was no indication of specialized fire‑safety equipment being used during these observations.

Another resident with tobacco use, cataracts, vascular dementia, and a documented smoking safety evaluation indicating poor vision, balance problems, and inability to safely light, hold, or extinguish cigarettes was observed being wheeled to the smoking area without being offered a smoking apron. The LPN left this resident outside alone with his own cigarettes and lighter, and the resident confirmed that staff did not supervise him while he smoked. The 500‑unit smoking area lacked a fire extinguisher, fire blanket, and fire‑safe ashtrays, with only large metal cans present. A third resident with epilepsy, neuropathy, hemiplegia, and upper extremity impairment was similarly assessed as having balance problems and limited range of motion, yet was observed wheeling himself with a cigarette and lighter in hand, refusing a smoking apron, and smoking outside alone after staff left the area; he confirmed he kept his cigarettes and lighter, and used non‑fireproof metal cans for cigarette disposal.

A fourth resident with a history of stroke and seizure disorder had a smoking safety evaluation documenting balance problems, burning of skin and clothing, dropping ashes on self, non‑adherence to smoking location and time policies, and inability to safely extinguish cigarettes or use an ashtray. The care plan stated this resident often declined a smoking apron, was supposed to keep cigarettes at the nurse’s station, and needed reminders to follow the smoking schedule and designated area. Despite this, the resident was observed in his room with a pack of cigarettes and a lighter concealed under a washcloth on the wheelchair armrest, and later was seen smoking outside the 500‑unit smoking area without staff supervision, confirming he kept his cigarettes and lighter.

Another resident who smoked and used oxygen via nasal cannula with an oxygen concentrator in her room was care planned to have aides assure proper storage of smoking materials, with cigarettes kept at the nurse’s station and some cigarettes in her room. Her smoking safety evaluation indicated she could safely light, hold, and extinguish cigarettes and use an ashtray, but staff interviews revealed that while her cigarettes were stored at the nurse’s station, she kept her own lighter in her private room. Multiple staff, including RNs and CNAs, acknowledged that it was not appropriate for a resident using oxygen in the room to keep a lighter there. The facility’s administrator and other leadership confirmed that residents from the 500 unit using the back smoking area did not require supervision, that residents were permitted to keep cigarettes and lighters if care planned, and that there were no smoking blankets in either the front or back smoking areas. The maintenance director verified that the necks to the safety ashtray bottoms were not attached in the smoking areas. The report also cites NFPA 99 provisions requiring removal of smoking materials from patients receiving respiratory therapy and prohibiting smoking in areas where oxygen is used or stored.

Immediate Jeopardy was identified when three residents with upper extremity impairments who smoked were found to be unsupervised and retaining their smoking materials, and the facility’s practices and environment did not align with the documented risks and applicable fire safety standards.