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.
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.
A resident with moderate cognitive impairment and a history of respiratory conditions was taken by a CNA to a non-designated patio area to smoke, despite not being authorized to do so. Staff interviews revealed confusion about which residents were permitted to smoke and where, leading to the resident smoking in an unsafe area and causing a fire that required emergency response. The facility's policy required smoking only in designated areas, but this was not followed.
A resident was found to have cigarettes and a lighter stored in a bag on their walker in their room, contrary to the facility's smoking policy requiring all smoking supplies to be kept locked at the nurse's station and only accessed under staff supervision. Staff were unaware of the presence of these supplies, did not remove them, and did not report the incident, despite being trained on the policy. The facility's policy prohibits residents from keeping smoking articles except when directly supervised.
A staff member was observed vaping between the nurse's station and a resident sitting area while residents were present, in violation of the facility's non-smoking policy. Interviews with staff and residents confirmed that the facility prohibits smoking and vaping inside, and that staff are only allowed to smoke in a designated outdoor area. The incident was directly observed by a surveyor, and the staff member involved denied remembering the event but acknowledged using vapes and cigarettes.
A facility failed to enforce its smoking policy when a CNA was observed using a vape device while providing care to a cognitively impaired resident with multiple medical conditions. The incident occurred in a non-designated area, contrary to facility policy, and was confirmed through video evidence and staff interviews.
A designated smoking area was found with a fire can containing a plastic liner, cigarette butts, and paper and plastic trash, contrary to facility policy. Staff interviews revealed confusion about responsibility for maintaining the smoking area, and the Maintenance Director was unaware of proper procedures. The facility's policy required metal containers for ash disposal, but this was not followed, resulting in an unsafe smoking environment.
A resident with multiple medical conditions and a safe smoking assessment was found to be keeping a lighter and cigarettes in her room, contrary to facility policy requiring smoking materials to be stored at the nurse's station. Staff interviews revealed inconsistent enforcement of the policy, and the resident's care plan had not been initiated at the time of the survey.
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