Failure to Implement Required Smoking Safety Interventions
Penalty
Summary
The deficiency involves the facility’s failure to implement required smoking safety interventions for a resident assessed as needing a smoking apron. The resident had an MDS indicating intact cognition with a BIMs score of 14, but was dependent on staff for bed mobility and transfers and had diagnoses including diabetes mellitus, arthritis, CVA with hemiparesis, and adjustment disorder with mixed anxiety and depressed mood. The care plan identified a focus problem related to tobacco use and specified that the resident was to utilize a smoking apron. A Smoking and Safety Assessment documented that the resident had balance problems while sitting or standing, limited or no range of motion in arms or hands, insufficient fine motor skills to securely hold smoking items, and a tendency to drop ashes on self. The assessment concluded the resident was independent with smoking only with a required safety device, specifically a smoking apron. Despite these documented needs and care plan directives, surveyors observed the resident smoking independently in the courtyard on multiple occasions without wearing a smoking apron. On one occasion, a CNA reported assisting the resident outside to smoke and acknowledged she did not offer a smoking apron and was unaware the resident was supposed to use one. On another occasion, the ADON reported that when she offered the apron, the resident refused it, stating the apron complicated her ability to smoke. The facility’s Smoking/E-Smoking Policy required residents to be assessed for smoking safety and for identified provisions such as smoking aprons to be implemented, with noncompliance addressed through counseling and possible suspension of smoking privileges. The observations and staff interviews showed that the resident’s assessed and care-planned smoking safety intervention of a smoking apron was not consistently implemented.
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