Failure to Enforce Smoking Policy Allowing Resident to Keep Cigarettes/Cigars in Room
Penalty
Summary
The deficiency involves the facility’s failure to follow its smoking protocol by allowing a resident to keep smoking materials in their room. During observation, the resident was first seen lying in bed and reported smoking cigars, stating that he did not keep a lighter in his room and that others lit his cigars for him, while he kept the cigars in his coat pocket. Shortly thereafter, the resident was observed going to his closet, removing his coat, and taking out a box filled with brown cigarettes/cigars, followed by an additional 8–10 brown cigarettes/cigars from the same coat pocket. Later, the social worker entered the resident’s room and found in the coat pocket a box of cigarettes/cigars, three additional unused cigarettes/cigars, and six used cigarettes/cigars of various lengths, and stated the resident should not have these items in his room for safety reasons. Staff interviews confirmed that the facility’s practice and policy require all smoking materials, including cigarettes/cigars and lighters, to be stored at the front desk and not kept on the nursing unit or in resident rooms. The activity aide, receptionist, and social worker each stated that residents are only allowed to have smoking materials on their person during supervised smoke breaks and must return all materials to the front desk afterward. The resident involved had multiple diagnoses including metabolic encephalopathy, bipolar disorder, unspecified dementia, cocaine abuse, schizophrenia, mild cognitive impairment of uncertain etiology, auditory hallucinations, tobacco use, alcohol use, and altered mental status. His MDS showed severely impaired cognition with a BIMS score of 3/15. His care plan identified him as a smoker who wished to smoke at the facility, with interventions including explaining the consequences of smoking and removal of all smoking materials except during supervised smoking. A smoking behavior agreement and smoking program evaluation documented that he was considered a safe smoker and could access smoking materials consistent with facility policy, yet the presence of multiple cigarettes/cigars in his room demonstrated that the facility did not ensure adherence to its own smoking protocol.
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