Failure to complete quarterly smoking evaluation for a dependent smoker. A resident with dementia was identified as needing direct supervision to smoke, but the record showed no updated smoking evaluation after the initial assessment. Staff stated smoking assessments were to be completed on admission and quarterly, and an observation found the resident smoking with difficulty holding the cigarette.
A resident with mild cognitive impairment and tobacco use had cigarette packs on his bedside table despite a care plan requiring supervised smoking, designated smoking times and areas, and storage of all smoking supplies in a locked box at the nurse’s station. The resident said he usually kept his cigarettes on the table and got them from the store when he went out. Staff, including the ADON, CNA, RN, and DON, stated that residents were not allowed to keep cigarettes or lighters in their rooms and that smoking materials were to be secured and used only during supervised smoke times.
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.
Failure to Complete Required Smoking Safety Evaluations: The facility did not complete required smoking safety evaluations for five residents with smoking preferences and smoking-related risk factors. Records showed that some residents required supervision because of impaired dexterity, unsafe smoking habits, or falling asleep while smoking, yet quarterly or annual evaluations were not updated as required. During observation, some residents were smoking with staff supervision while others were smoking independently in the designated area, and the ADON and DON acknowledged that some evaluations were overdue or not clearly documented.
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.
Smoking Area Not Kept Free of Trash: A facility failed to follow its smoking policy when paper and plastic trash were found in ashtrays and a red fire can in a designated smoking area. An observation showed empty cigarette boxes in an ashtray and plastic cups and a plastic bottle in the fire can. Staff interviews indicated the trash was often placed there by staff, the area was cleaned daily by housekeeping or maintenance, and the ashtrays and fire can were intended for cigarette butts only.
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.
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