Failure to Enforce Safe Smoking Policy and Supervision for a Resident
Penalty
Summary
The deficiency involves the facility’s failure to ensure a resident received adequate supervision and adherence to the facility’s safe smoking policy. The resident was a 37-year-old male with paraplegia, anxiety disorder, and major depressive disorder, who had no documented cognitive impairment per an MDS assessment. His care plan included a focus on noncompliance with smoking rules and prior findings of vapes in his bed. He had signed a Resident Smoking Behavior Contract acknowledging that failure to comply with smoking safety regulations could result in suspension or revocation of smoking privileges and could jeopardize his ability to remain in the facility. Multiple progress notes and staff interviews documented repeated concerns that the resident was smoking in his room and possessing prohibited smoking materials. A DON progress note described a smell of smoke highly suggestive of cannabis from the resident’s room, with police confiscating a substance surrendered by the resident. Another note by an LVN documented finding two packs of cigarettes in the resident’s room and the resident attempting to conceal the extent of his cigarette possession. Additional documentation showed that the resident was observed smoking behind the laundry building outside of designated smoking times and that he produced a black lighter from his sock to light a cigarette after claiming he had not smoked at a scheduled smoke break. Staff interviews further described smelling cigarette smoke in the resident’s room and observing him with lighters hidden under his wheelchair cushion. CNAs reported seeing black and blue lighters in his possession and smelling smoke in his room, and they stated they informed nurses but did not escalate directly to the Administrator or DON. The DON, Administrator, ADON, LVNs, CNAs, PMHNP, NP, and RNC all acknowledged concerns or beliefs that the resident was smoking in his room or was noncompliant with smoking rules, and several stated he was not supposed to have lighters per facility policy. The facility’s Safe Smoking policy required that staff maintain all smoking materials, restrict smoking to designated times and areas, and assess residents’ ability to smoke safely, with recommended actions for infractions including a behavioral contract and potential involuntary discharge. Despite these policies and the resident’s contract, the resident continued to have access to cigarettes and lighters and was repeatedly associated with smoke odors and off-schedule smoking, demonstrating a failure to ensure adherence to the safe smoking policy and adequate supervision to prevent accidents.
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