F0689

J

Failure to Enforce Smoking Policy and Supervise Oxygen-Dependent Smoker

Chouteau, Oklahoma Survey Completed on 03-17-2026

Penalty

Fine: $21,645

Summary

The deficiency involves the facility’s failure to provide adequate supervision and prevent accident hazards related to smoking, resulting in a resident smoking in their room while wearing oxygen and sustaining facial burns. The facility had a written smoking policy stating that residents would not be allowed to have cigarettes, matches, or lighters in their possession or in their rooms, and that no smoking was permitted in resident rooms or hallways. Despite this, the resident was able to obtain and use smoking materials in their room. Staff, including the administrator and DON, acknowledged that housekeeping had previously found ashes on the resident’s toilet seat and that the resident had been reported to have smoked in their room multiple times over a two‑month period.

The resident involved had diagnoses including COPD, lung cancer of the right lower lobe, respiratory failure, anxiety, depression, and paranoid schizophrenia, and used oxygen. Assessments showed the resident was cognitively intact with a BIMS score of 15 and was identified as a smoker. A smoking assessment documented on 11/12/25 indicated the resident could safely smoke with minimal supervision, and a subsequent assessment on 02/12/26 noted the resident had been observed hiding a cigarette in their pocket to smoke later, yet still concluded they could safely smoke with minimal supervision. A nurse progress note on 02/12/26 recorded that staff had observed the resident placing a cigarette in their jacket pocket and had educated the resident on the dangers of smoking while wearing oxygen.

Despite these documented concerns and prior observations of unsafe smoking behavior, the resident continued to access smoking materials and smoke in their room. A nurse progress note dated 03/03/26 recorded that the resident had smoked in their room the night before while wearing oxygen, resulting in burns to the resident’s face. On observation, the resident was noted to have singed mustache hair and a wound near the upper lip. The administrator reported that the maintenance director later found a lighter under the resident’s bed and that it had been reported the resident had smoked in their room six times between early January and early March. Staff interviews confirmed that residents were not supposed to have smoking materials in their possession and were to be supervised while smoking, but also revealed that there was no guarantee that all lighters and cigarettes had been removed from the resident’s room.