F 0689
Level of Harm - Minimal harm
or potential for actual harm
Residents Affected - Few
Ensure that a nursing home area is free from accident hazards and provides adequate supervision to
prevent accidents.
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on
observation, interview and record review, the facility failed to implement smoking precaution, by not
providing a smoking apron (worn while smoking to help decrease incidents of burning self), to one of four
residents (Resident 1) while smoking cigarette at the facility patio.
This failure had the potential for Resident 1 to sustain burn injuries while smoking a cigarette.
Findings:
On May 9, 2025, at 10:30 a.m., an unannounced visit was made to the facility to investigate a
quality-of-care issue.
On May 9, 2025, at 10:50 a.m., during an observation of residents smoking on the patio, the Activity
Assistant (AA) was observed taking the smoking apron and placing the apron to Resident 1 who was
almost done smoking his cigarette. The AA stated she forgot to put the smoking apron to the resident
(Resident 1).
On May 9, 2025, at 10:53 a.m., during an interview, the AA stated she was on the patio to supervise the
residents smoking. The AA stated, when residents smoke, she would hand out the cigarettes and an apron
to those who are required to wear them, then light their cigarettes. The AA stated the resident (Resident 1)
is blind, and the resident should wear an apron to prevent burns. The AA verified Resident 1 was not
wearing a smoking apron, while smoking because she forgot to hand him (Resident 1) one.
On May 9, 2025, at 10:57 a.m., during an interview, Resident 1 stated he is supposed to wear an apron
when smoking, and to return the apron back to the staff when done. The resident verified he was not
wearing a smoking apron when he was smoking.
On May 9, 2025, at 11:32 a.m., during an interview, the Activities Director (AD) stated nursing staff would
complete a smoking assessment on all smokers, and from this assessment, it would be determined if a
resident is required to wear a smoking apron for safety. The AD stated the activity staff would monitor
smoke breaks, and ensure residents are wearing their smoking apron, prior to lighting their cigarettes. The
AD stated she would expect the staff to ensure residents are wearing their smoking aprons while smoking.
A review of Resident 1 ' s admission record dated, May 9, 2025, indicated the resident was admitted to the
facility on [DATE], with diagnoses which included chronic obstructive pulmonary disease
(continued on next page)
Any deficiency statement ending with an asterisk (*) denotes a deficiency which the institution may be excused from correcting providing it is determined that other
safeguards provide sufficient protection to the patients. (See instructions.) Except for nursing homes, the findings stated above are disclosable 90 days following the
date of survey whether or not a plan of correction is provided. For nursing homes, the above findings and plans of correction are disclosable 14 days following the date
these documents are made available to the facility. If deficiencies are cited, an approved plan of correction is requisite to continued program participation.
LABORATORY DIRECTOR'S OR PROVIDER/SUPPLIER
REPRESENTATIVE'S SIGNATURE
TITLE
(X6) DATE
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Facility ID:
If continuation sheet
Page 1 of 2
Event ID:
056428
Printed: 05/15/2026
Form Approved OMB
No. 0938-0391
Department of Health & Human Services
Centers for Medicare & Medicaid Services
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION
(X1) PROVIDER/SUPPLIER/CLIA
IDENTIFICATION NUMBER:
(X2) MULTIPLE CONSTRUCTION
056428
B. Wing
A. Building
(X3) DATE SURVEY
COMPLETED
06/17/2025
NAME OF PROVIDER OR SUPPLIER
STREET ADDRESS, CITY, STATE, ZIP CODE
California Nursing & Rehabilitation Center
2299 North Indian Canyon Drive
Palm Springs, CA 92262
For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency.
(X4) ID PREFIX TAG
SUMMARY STATEMENT OF DEFICIENCIES
(Each deficiency must be preceded by full regulatory or LSC identifying information)
F 0689
(COPD-a group of lung diseases that make it difficult to breath), and legal blindness.
Level of Harm - Minimal harm
or potential for actual harm
A review of Resident 1 Brief Interview of Mental Status (BIMS- a cognitive assessment) indicated a score of
12, which meant moderate cognitive impairment.
Residents Affected - Few
A review of Resident 1 ' s, Smoking and Safety, assessment dated [DATE], indicated, . Poor vision or
blindness . Care Planning: Tobacco Use; Intervention: Utilize smoking apron .
A review of Resident 1 ' s, Care Plan, titled, Tobacco use, dated, February 25, 2025, indicated, . Resident
needs supervision during smoking schedule with the use of apron due to total blindness .
On May 9, 2025, at 3:30 p.m., during an interview, the Director of Nursing (DON) stated a staff member has
to supervise residents while smoking in the patio. The DON stated Resident 1 should have a smoking apron
prior to staff lighting his cigarette for safety. The DON verified that Resident 1 was not wearing the smoking
apron while smoking at the patio. The DON stated the AA knew the smoking policy and that the resident
(Resident 1) should have a smoking apron when smoking.
A review of the facility Policy & Procedure (P&P) titled, Smoking Residents, revised, July 27, 2023,
indicated, . Procedure: 2. Smoking by residents is allowed outside the facility in designated, marked
smoking areas with the following safety measures readily available . d. Fire-retardant blanket (Smoking
blanket) . 6. Using the Resident Smoking Assessment, the licensed Nurse will assess residents who
express a desire to smoke, upon admission, quarterly, annually and upon significant change of condition,
and present it to the interdisciplinary Team (IDT) for review .
FORM CMS-2567 (02/99)
Previous Versions Obsolete
Event ID:
Facility ID:
056428
If continuation sheet
Page 2 of 2
