The facility failed to enforce its smoking policy and safe smoking assessments for three residents who used tobacco. One resident with mild cognitive impairment and two residents without cognitive impairment were assessed as smokers who required the facility to store their cigarettes and lighters, yet they reported keeping these items in their rooms, and surveyors observed cigarettes and lighters in bedside furniture. An LVN and the housekeeping supervisor stated that all smoking was to be supervised and that supplies were to be kept at the nurse’s station, and the DON and ADM confirmed that residents were not supposed to keep smoking articles in their rooms. However, residents reported they had not been told they could not keep smoking supplies in their rooms, and the facility’s written policy stated residents may not have or keep smoking articles except under direct supervision.
Unsafe Smoking Area Maintenance and Policy Enforcement: The facility failed to enforce smoking safety policies in a smoking area outside the dining room. An observation found paper trash in ashtrays and cigarette butts in a trash can with a plastic liner. The Maintenance Supervisor and Administrator both stated trash should not be in ashtrays and cigarette butts should not be placed in the trash, and the facility policy stated ashtrays are emptied only into designated receptacles.
Smoking Area Fire Cans Contained Trash: The facility failed to enforce its smoking policy in the main designated smoking area under the car port. An observation found two red fire cans containing cigarette butts, empty cigarette paper boxes, soda cans, chip bags, and other paper and plastic trash. The Maintenance Director said he was responsible for maintaining the smoking areas and emptying the fire cans, and the DON stated staff assisting residents with smoking should ensure there was no trash in the red fire can. The facility policy stated that ashtrays were to be emptied only into designated receptacles.
Cigarette butts were found in a trash can in the smoking area instead of in the designated locked red butt can. CNA K, the HSK Supervisor, and the Administrator all stated that ashtrays were supposed to be emptied into the red smoking can after each smoke break, and the facility's smoking policy required ashtrays to be emptied into a metal container with a self-closing cover device.
Failure to Follow Designated Smoking Area Policy: A dietary aide was observed smoking on the sidewalk near the kitchen back door instead of in the designated smoking area. She said she sometimes smoked in her truck or in rocking chairs in front of the facility and believed she could smoke anywhere outside. The Administrator and HR Coordinator stated staff and residents were expected to use the same designated outdoor smoking area, and the facility policy required employees, residents, medical staff, and visitors to smoke only in that area.
The facility failed to follow its smoking policy for multiple smokers by not completing required smoking assessments on admission and quarterly. A SW said she was responsible for the assessments but did not know one resident was a smoker until the week before survey, and his assessment was not completed until the day of the interview. The DON and ADM said they were unaware the assessments were not being completed, and the policy required evaluation of smoking status and safe smoking ability with quarterly re-evaluation.
A resident with dementia, epilepsy, prior TIA/CVA, depression, and tobacco use was found keeping cigarettes and a lighter in his sweater pocket and lighting his own cigarette without staff assistance. His care plan required smoking materials to be kept at the nurse’s station, and the facility’s smoking policy stated all smoking materials must be secured there when not in use. The ADM stated residents were not allowed to keep smoking materials or lighters in their rooms, while the Driver reported the resident continued to keep them with him and smoke independently.
A resident with psychiatric diagnoses but intact cognition, who had been evaluated as safe to smoke independently and educated on the facility smoking policy, was observed smoking in a front patio area instead of the designated smoking area. Staff were seen entering and exiting without intervening, despite a care plan goal to prevent smoking-related accidents and observe for unsafe smoking behaviors. The DON acknowledged prior awareness that this resident did not always follow the smoking policy and confirmed that smoking was permitted only in the designated outdoor area equipped with safety devices.
Smoking Area Safety and Disposal Deficiencies: During a smoke break, five residents were observed in a smoking area with cigarette butts on the ground, trash in the red cigarette butt receptacle, and a malfunctioning self-closing ashtray. Staff interviews showed the DSD, Maintenance Director, Housekeeping Supervisor, ADON, and Administrator were aware the area should be kept clear and the ashtrays functioning, but the facility’s smoking policy requiring metal containers with self-closing cover devices and designated receptacles was not being followed.
Smoking assessments were not completed on a quarterly basis for two residents who smoked. Both residents had BIMS scores of 15 and were able to make independent decisions, but one resident also had dementia, schizophrenia, and PVD, while the other had ESRD, DM with neuropathy, dialysis dependence, and major upper-extremity amputations requiring staff assistance to smoke. The DON and Administrator stated assessments were expected on admission, quarterly, and with any change in smoking status, but the records showed the assessments were not regularly completed.
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