Failure to Treat Smoking Residents With Dignity and Respect
Penalty
Summary
The deficiency involves failure to ensure residents were treated with dignity and respect during staff-assisted smoking breaks. A female resident with hepatic encephalopathy, acute respiratory failure, morbid obesity, and intact cognition (BIMS 14) required varying levels of assistance with ADLs and had a care plan identifying her as a smoker who needed assistance to and from the smoking area. A male resident with cellulitis of the left lower limb, severe sepsis with septic shock, non-pressure chronic ulcers, and moderately impaired cognition (BIMS 12) was independent in ADLs and had a care plan indicating he smoked and required supervised smoking due to noncompliance with facility policy. During a smoking break, both residents reported that a CNA made rude comments about taking them outside to smoke, including telling the male resident that he was always hassling her about smoking and telling the female resident that she did her the same “damn” way, which the female resident stated made her feel talked down to and upset. Additional interviews with three other residents who smoked indicated they had heard staff say it was a hassle taking them outside to smoke, though they could not recall specific dates, times, or staff names and reported no distress from those incidents. The CNA involved denied using inappropriate language or telling residents their care was a hassle. The DON stated that staff were expected to maintain professional behavior, including not cursing or using inappropriate language, and acknowledged that a CNA talking down to or using inappropriate language around a resident could put the resident at risk for emotional distress. The administrator reported responsibility for investigating allegations of abuse and neglect and described investigating the allegation that the CNA used inappropriate language and talked down to the two residents. Facility documentation showed that the CNA was discharged for speaking to residents in a manner that could be perceived as inappropriate language or talking down to residents, and for inappropriate behavior, in the context of a facility policy stating residents have the right to be treated with courtesy, consideration, and respect.
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