A resident with intact cognition and physical weakness was allowed to keep cigarettes on his person, but the facility had no documented safe smoking evaluation, no smoking care plan area, and no smoking assessments in the EMR. Staff also observed smoking in a no-smoking area on the back patio, where no-smoking signs, an ashtray, and a trash can were present, while the ADM stated residents were allowed to smoke unsupervised and smoking items were found in non-designated areas.
A facility failed to enforce smoking safety policies in the smoking area for halls C/D when a red butt can was found holding cigarette butts plus a plastic wrapper, gloves, and a plastic wrist band. The Housekeeping Supervisor, ADON, DON, RDO, Administrator, and Maintenance Supervisor all stated that the red cans were for cigarette butts only and that trash belonged in the trash can, while the Maintenance Supervisor said staff were always putting trash in the smoking can and a sign had been posted to remind staff.
Smoking Break Schedule Not Followed: A facility failed to enforce its smoking schedule and related smoking policies for residents who smoked. Several residents were scheduled for a 10:30 A.M. supervised smoke break, but they were still inside during observation and did not go out until later. Interviews showed the SS created the schedule, but staffing changes were not communicated timely, and staff reported the smoke breaks were often late.
A facility failed to complete smoking assessments for three residents who used tobacco. One resident had moderate cognitive impairment and diagnoses including dementia and nicotine dependence, another had severe cognitive impairment with diagnoses including intellectual disability and diabetes, and a third had intact cognition but required staff supervision for tobacco use. The smoking policy required admission and quarterly evaluations of smoking status and safety, but the assessments were not completed for any of the three residents.
Missing Smoking Assessments for Two Residents: The facility failed to establish and implement smoking safety policies for two residents who smoked and required staff supervision with tobacco use. Both residents had care plans calling for supervision, but their EHRs did not contain smoking assessments. The DON stated smoking assessments were required on admission and within 24 hours, and the facility policy required an admission evaluation of whether the resident could smoke safely with or without supervision.
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.
Missing Initial Smoking Assessment: A resident with moderate cognitive impairment and renal dialysis dependence continued to smoke despite multiple comorbidities, but the facility did not complete the required initial smoking assessment. The care plan identified the resident as at risk for smoking injury, and the DON stated smoking assessments were audited and should be completed on admission, while the facility policy required assessment of smoking ability and supervised smoking until the IDT review.
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.
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