F0689

E

Failure to Conduct and Implement Safe Smoking Assessments and Controls

El Paso, Texas Survey Completed on 02-18-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to maintain a smoking environment free of accident hazards and to provide adequate supervision and assessment for multiple residents who smoked or wished to smoke. For one male resident with a history of daily tobacco use, multiple vascular diseases, diabetes, impaired mobility including a left below-knee amputation and toe amputations, and cognitive communication deficits, the facility documented nicotine dependence but did not complete a safe smoking assessment. His care plan addressed various medical conditions and included general education on adverse effects of tobacco, but it did not specify smoking supervision interventions, assistance to and from the designated smoking area, lighter control measures, fire prevention strategies, or individualized hazard mitigation despite his mobility and cognitive limitations. This resident reported he began smoking about a week after admission, requested staff to take him outside, and received cigarettes from staff in the designated smoking area, but he did not know if he had been evaluated for smoking or educated on the facility’s smoking policies.

Another male resident with diagnoses including nicotine dependence, COPD, respiratory failure with hypoxia, pneumonia, CKD stage 5, anemia, and bipolar disorder had inconsistent documentation regarding smoking status: nicotine dependence was listed as a diagnosis, but the social history stated he denied tobacco use. His quarterly MDS showed intact cognition with mild recall difficulty. His care plan addressed coronary artery disease and included an intervention to encourage him to refrain from smoking, but it did not include a specific smoking supervision plan, designated smoking area guidance, safety precautions, lighter control procedures, or fire risk mitigation interventions, and there was no safe smoking assessment in the electronic record. This resident stated he was a smoker, smoked in the designated area, staff provided his cigarettes and lit them for him, and he did not know if he had been assessed to smoke safely.

A third male resident with bilateral below-knee amputations, infections of the amputation stumps, muscle weakness, unsteadiness on feet, age-related cognitive decline, major depressive disorder, anxiety disorder, and on anticoagulant and diuretic therapy had a care plan identifying that he smoked. The plan stated he should smoke only in designated areas, have no oxygen present while smoking, be informed of the smoking policy, be prohibited from storing smoking materials or igniters in his room, and receive a monthly safe smoking assessment. He was considered safe to smoke unsupervised, and a safe smoking assessment documented that he knew the designated smoking area, could get there independently, and could safely light, extinguish, and dispose of smoking materials. However, during observation he was found in bed with a pack of cigarettes in his jacket pocket, which he said had just been given by family and that he was supposed to turn in to the facility for safekeeping, indicating that cigarettes were present in his room contrary to the care plan and policy.

A female resident with seizure disorder, metabolic encephalopathy, bipolar disorder, anxiety disorder, diabetic neuropathy, impaired vision requiring corrective lenses, chronic pain, obesity, and other chronic conditions had documentation in the history and physical that she denied tobacco use, and there was no documentation identifying her as a smoker. Her MDS showed moderately impaired cognition and need for supervision with eating, transfers, and toileting, but did not identify her as a smoker and contained no smoking status or assessment. Her care plan addressed hypertension, diabetes, diuretic therapy, impaired visual function, depression, and ADL self-care deficit, and included education on adverse effects of tobacco, but there was no problem statement identifying her as a smoker, no smoking risk assessment, and no interventions for supervision or safe smoking location. Facility record review confirmed there were no safe smoking assessments for her. During observation in the smoking area, she sat near other residents who were smoking while a CNA supervised the group; she stated she had started smoking about two weeks earlier, obtained cigarettes from other residents, did not know if she had been evaluated to smoke safely, and only knew she had to go outside to smoke.

Another male resident with dementia, hypertension, diabetes, atrial fibrillation, arthritis, GERD, and cognitive communication deficit had a social history documenting that he denied smoking at admission. His MDS showed moderate cognitive impairment and shortness of breath. His care plan addressed hypertension, diabetes, anticoagulant therapy, GERD, arthritis, and cognitive impairment, and included education encouraging avoidance of smoking for GERD management, and indicated that smoking materials were kept at the nurses’ station. However, prior to the survey the care plan did not clearly describe supervision frequency, monitoring for burns, or risk mitigation related to his dementia and anticoagulant therapy, and it was updated only on the date of the investigation. The safe smoking assessment on file, indicating he was safe to smoke unsupervised and that all smoking materials were kept at the nurses’ station, was completed by the investigator at the time of entrance, not by facility staff beforehand. During observation, this resident was found in bed with a pack of cigarettes in his nightstand and a lighter inside the pack; he stated he did not know he needed to inform the facility that he smoked, did not believe he had been evaluated to smoke safely, and said the cigarettes and lighter had been given by family the previous day.

Staff interviews further demonstrated gaps in the facility’s smoking safety practices. A CNA who supervised smoking breaks stated that cigarettes and lighters were kept in a locked box, staff handed out cigarettes, and residents were supervised while smoking, but she did not know which residents had completed smoking assessments and expressed concern that some residents with tremors and poor hand control might not have appropriate assessments. The DON stated that residents who identified as smokers on admission were supposed to receive a smoking assessment and that residents should not smoke without an assessment, but acknowledged that staff often relied on routine and smoking schedules rather than verifying current assessments. The ADON, Administrator, and Activities Director each stated that residents should be assessed before smoking and that residents having lighters or smoking equipment in their rooms could create fire hazards or result in burns or injuries. Review of the facility’s Uniform Smoke Free Policy showed requirements for assessments, prohibition of smoking in resident rooms, storage of smoking paraphernalia in secured areas, and direct supervision for residents assessed as unsafe, which were not consistently implemented for the residents reviewed.