Failure to Secure Vaping Device and Inadequate Fall Investigation and Neuro Checks
Penalty
Summary
The deficiency involves the facility’s failure to keep smoking/vaping devices secured and away from the bedside, and to provide adequate supervision consistent with its smoking policy. One resident with cirrhosis of the liver, a left above-knee amputation, and diabetes mellitus had a quarterly MDS showing intact cognition and a need for supervision with toilet hygiene and transfers, and set-up assistance for eating and bed mobility. A smoking safety evaluation documented that this resident used tobacco, required staff supervision for smoking, could not store smoking materials, and did not use electronic cigarettes or vaping devices. However, the smoking care plan did not specify whether the resident was independent or required supervision with smoking, and the smoking evaluation had not been updated for several months. During observation, the resident was found lying in bed with a vaping device on the bed near his hand, and he confirmed it was his vape and that he sometimes used it in his room. The MDS nurse present confirmed the vaping device was at the bedside, stated she was unaware the resident used a vaping device, and acknowledged that the smoking evaluation had not been updated. The facility’s smoking policy stated that smoking is only permitted in designated outdoor areas, that smoking is not allowed inside the facility under any circumstances, and that electronic cigarettes are permitted only in designated areas and with supervision. The policy also stated that residents without independent smoking privileges may not keep smoking items except under direct supervision. The facility also failed to adequately investigate and respond to a resident’s fall and to complete neurological checks after unwitnessed falls. A second resident, with hypertensive heart and chronic kidney disease, end stage renal disease, and anemia, had a quarterly MDS indicating intact cognition and a need for partial/moderate assistance with bathing, bed mobility, and transfers, and supervision with toilet hygiene. A fall risk assessment indicated only one to two falls in the prior three months and that the resident was not at risk for falls, but nursing notes documented multiple falls over a period of time, including unwitnessed falls. After one unwitnessed fall, there was no documentation that neurological checks were initiated, and a change of condition evaluation referencing the unwitnessed fall lacked accompanying nurse progress notes about the fall. The facility incident log contained no evidence of an investigation or implementation of interventions for that fall, and an LPN confirmed that neurological checks were not documented after two of the falls and that no investigation or interventions were completed for one of the falls, contrary to the facility’s fall response procedure requiring immediate assessment, documentation, neurological checks for unwitnessed falls, and care plan updates.
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