Health inspection·February 4, 2022

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, staff interviews, policy and record review, the facility failed to ensure that a safety device of a protective smoking apron was worn for one (1) resident (Resident #29) of six residents who smoke, failed to ensure the red metal smoking receptacle in the smoking area contained only smoking butts, for two of four days (02/01/2022 and 02/04/2022); and failed to follow their policy related to providing a safe smoking environment by not placing a required smoking fire blanket in the smoking area for three of four days (02/01/2022, 02/02/2022 and 02/03/2022) observed during the survey. Findings included: On 02/01/2022 at 11:02 a.m., an observation was conducted of Resident #29 seated in a chair on the smoking patio. The resident was observed to be supervised by an unidentified staff member. Resident #29 was not wearing the smoking device of a safety apron while smoking. During the observation, the red metal smoking butt receptacle located on the smoking patio, was opened by the surveyor, which contained cigarettes, four (4) empty cigarette packages of which two (2) were red and two (2) green in color, with one white plastic knife in with the cigarette butts. A safety smoking blanket was not located in the smoking area. It was observed to be located where residents perform activities next door to the smoking patio. (Photographic Evidence Obtained.) During an observation conducted of facility smoking area on 02/02/2022 at 9:05 a.m., Resident #29 was smoking without a safety apron on and was being supervised by Staff A, Certified Nursing Assistant (CNA). The smoking safety blanket was seen again located in the same area as the previous day. An immediate interview was conducted with Staff A, (CNA) who was asked what her duties were while she was supervising the residents in the smoking area. Staff A, (CNA) stated I supervise them, and give them their cigarettes that are locked up, I document how many they started out with and how many they completed smoking. I also disinfect the tables, I do not empty the ashtrays or the red bins, the housekeeper does that. Staff A (CNA) indicated that the smoking safety blanket was in another room. A subsequent observation was conducted on 02/02/2022 at 11:17 a.m. conducted during the 11:00 a.m. -11:30 a.m. smoking time frame, which revealed that Resident #29 was not wearing the smoking apron and the smoking blanket was not seen to be in the smoking area. Record review of the care plan dated 11/17/2021, indicated Resident #29 should be observed for smoking safely by staff, and required an apron to be worn while smoking. The intervention was initiated on 01/10/2022. Review of the Quarterly Minimum data Set (MDS) dated [DATE], indicated the Brief Interview for Mental Status (BIMS) Score was 15, (on a 1-15 score range) indicating cognitively intact. Page 1 of 3 105280 105280 02/04/2022 Tarpon Bayou Center 515 Chesapeake Dr Tarpon Springs, FL 34689

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few On 02/02/2022 at 01:41 p.m., an observation was conducted of Resident #29 and the smoking area. Resident #29 was seen having his cigarette lit by Staff A, (CNA), and was not wearing a smoking apron. The smoking blanket was not observed to be in the smoking area. An observation was conducted on 02/03/2022 at 09:05 a.m. of Resident #29 not wearing a smoking apron while smoking, and the smoking blanket was not in the smoking area. An interview was conducted with the Director of Nursing (DON) on 02/03/2022 at 11:30 a.m. During the interview the DON confirmed that the fire blanket was not located in the smoking patio. At 11:38 a.m. the DON was asked about Resident #29 not wearing a smoking apron while smoking, as indicated in his care-plan. She stated I put in smoke with a smoking apron, because of an audit done that day, I am not sure why it was done. On 02/03/22 at 11:59 a.m., the DON stated I put up the fire blanket in the smoking area, and the smoking book shows that Resident #29 needs to be wearing an apron. The CNA should be giving the resident the apron. I will re-valuate him today at 1:30 pm to see if he really needs to wear the apron. On 02/03/2022 at 01:36 p.m., an observation was conducted of Resident #29 wearing a smoking apron, and the DON watching the resident while typing on her laptop. Staff A, (CNA) was outside supervising the resident at the time. On 02/04/2022 at 12:23 p.m., an observation was conducted of the red aluminum smoking receptacle containing two white pieces of unidentified material on top of the smoking butts. (Photographic Evidence Obtained.) An immediate interview was conducted with the NHA, who confirmed the presence of the material on top of the smoking butts, that should not be in there and stated, I just did training on this on Tuesday (2/01/2022), I would expect that they place nothing but cigarette butts in the red can and put in the garbage can other items. A review of Facility Policies and Procedures, Topic: Smoking/Tobacco Use Dated: October 2017, Pages 01-03 of 04, read as follows: POLICY: The objective of this policy and procedure is not to discourage or restrict one's smoking privileges, but to promote safety for residents, visitors, and employees within the facility. EMPLOYEE EXPECTATIONS: -Monitor residents in the smoking area -Ensure appropriate adaptive smoking equipment is available and in use for residents as care planned -Provide a smoking fire blanket and fire extinguisher (water) within the designated smoking area SMOKING SAFETY: 3. Donning a smoking apron is encourage for residents that smoke, but not required unless deemed 105280 Page 2 of 3 105280 02/04/2022 Tarpon Bayou Center 515 Chesapeake Dr Tarpon Springs, FL 34689

F 0689 necessary by the interdisciplinary team during individual review. Level of Harm - Minimal harm or potential for actual harm 6. Remain with the smoker until the end of the smoking session and the cigarette has been successfully distinguished. Residents Affected - Few 105280 Page 3 of 3