Failure to Secure Resident Smoking Materials per Facility Policy
Penalty
Summary
The facility failed to secure smoking materials in accordance with its smoking policy, which required all resident smoking materials to be maintained in a secure lock box at the nurses' station when not in use. A cognitively intact resident with a history of cerebral infarction with resulting hemiplegia, hemiparesis, aphasia, dysphagia, vascular dementia with mood disturbance, and anxiety was observed sitting in a day room with a lighter and two cigarettes concealed in the bottom of his shirt. His MDS indicated he required assistance with several ADLs and was coded for tobacco use. A smoking evaluation documented that he was considered an independent, safe smoker whose preference to smoke independently at times of his choice was honored. During interviews, one nurse stated she had not provided the resident with smoking materials and did not know where the cigarettes or lighter came from, and also reported she was unfamiliar with the smoking policy because it was her first time working on that hall. Another nurse, who regularly worked with the resident, acknowledged she was aware that he did not turn in his lighter after smoking and that residents were allowed to smoke whenever they wished, making it difficult for staff to track smoking times. She stated that residents were supposed to give their lighters and cigarettes to the nurse upon returning from smoking, but this was not occurring with this resident, who liked to keep his lighter due to frequent smoking. The Administrator confirmed that cigarettes were to be kept in a locked box at the nurses' station and that nurses were supposed to confiscate lighters after each smoking session, but also stated that residents had effectively been allowed to decide whether to turn in lighters at the end of each session or at the end of the day, with some residents keeping lighters because they smoked frequently.
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