Health inspection·April 8, 2023

F 0689 Level of Harm - Minimal harm or potential for actual harm Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. Based on observation, interview, and record review the facility failed to ensure residents did not smoke/vape in the facility. This failure applied to one (R2) of one resident reviewed for supervision. Residents Affected - Few The findings include: On 4/8/23 at 8:05 AM, there was a strong smell of marijuana on the first floor upon exiting the elevator. At 1:25 PM, V6 Nurse showed this surveyor R2's vape pen stored in the medication cart. The pen was a nicotine pen and did not smell of marijuana. On 4/8/23 at 8:58 AM, V2 Director of Nursing (DON) stated we keep taking away a vape pen from a resident identified as R2. R2's nicotine vape pen smelled like marijuana, so we keep it in the nurse's cart. V2 was notified by this surveyor that the second floor smelled of marijuana at 8:05 AM today. V2 stated R2 probably has another vape pen. R3 and R7 smoke cigarettes and go outside to smoke. Smoking hours are 7-8 or 8-8. At 9:56 AM, R4 stated, It already started this morning. I smell marijuana on the first floor. R4 stated that R2 smokes in her room and sprays air freshener or opens her window. I know the smell of it. I was around it at home and used to smoke it to help with a chronic medical condition. At 10:13 AM, R5 stated there's a marijuana smell in the hall. It happens when there's no Administrator or anyone in the building. I think it comes through the air vent outside our room. R2 is doing it (mentioned her by name). She has shown it to me before. She smokes joints and smokes it out of a vape. I know the smell of pot. My son smokes it. She does not go out at smoking times. It's highly dangerous. We have oxygen on this floor, and she smokes it in her room. I told the Administrator about the concerns of marijuana smoking in the building. She said she'll look into it. Some other residents are afraid to say anything about the pot smoking bothering them. They're afraid of her (R2). At 10:21 AM, R6 stated I have trouble breathing. I use that machine at night. Just talking to R2 you can smell it (marijuana) on her breath. I can smell it in the hallway. It's offensive. It aggravates my breathing. She smokes it almost every day. V1 Administrator and V2 DON talked to her about it. R2 is the only pot smoker here. She does not go outside to smoke her pot. She should go outside to do it. At 10:36 AM, R3 stated there's only two people who go out to smoke here, me and another guy (R7). Page 1 of 2 145658 145658 04/08/2023 Aliya of Palatine 24 South Plum Grove Road Palatine, IL 60067

F 0689 Level of Harm - Minimal harm or potential for actual harm At 10:55 AM, V4 Certified Nursing Assistant (CNA) stated I smell marijuana when I work here. I usually work on the weekends, and I smelled it this morning. At 1:15 PM, V3 Certified Nursing Assistant stated R3 and R7 are the only two residents who go outside to smoke. Residents Affected - Few At 1:20 PM, R7 stated he and R3 are the only two resident who go outside to smoke. R7 stated R2 has a vape and you can't smell it, so she doesn't go outside. At 1:25 PM, V6 nurse stated R2's vape pen is kept in the medication cart. R2 has not taken it all day. At 2:00 PM, V1 Administrator and V2 Director of Nursing were unable to explain why R2 never goes outside to smoke. The facility's 3/13/23 Resident Council Meeting Minutes showed a resident stated they could smell someone smoking marijuana and the smell upsets her. A 4/7/23 grievance by R4 reporting R2 had a weed smell like. R2 denied the allegation. The grievance was not substantiated. There was no evidence other residents were interviewed for the investigation. The facility's 10/24/22 Smoking Safety Policy showed a Smoking Safety Assessment will be completed to determine the level of assistance and supervision needed during smoking, the ability to carry and store smoking materials, and if a smoking apron is indicated. The plan of care shall reflect the results of this assessment. This assessment will be completed upon admission, quarterly and with significant change. If a resident chooses to smoke electronic cigarettes (e-cigarettes, vapes, vaporizers, vape pens etc.,) they must smoke them in designated smoking areas outside. A Smoking Safety Assessment will be completed to ensure that the resident is capable of safe storage, charging and use of the electronic cigarette or vaping device. Individuals who are non-compliant, potentially dangerous, exercise poor judgement, and show a lack of concern for the welfare of others will be counseled accordingly. The facility maintains the right to limit and restrict access to smoking products, matches, and lighters for persons deemed unsafe. Smoking privileges will be revoked if there is a pattern of persistent, hazardous behavior. No resident may smoke near/around oxygen. The following behaviors and/or conditions will jeopardize and/or cause revocation of the person's independent privileges: Smoking in any non-designated area, such as resident rooms .Consequences of non-compliance: Residents will be instructed, educated and counseled about their inappropriate behavior. Safe, appropriate behavior will be stressed. Documentation will be entered into the record accordingly. Further incidents of non-compliance may result in loss of independent privileges which means smoking materials will be turned over to a designated staff member., held in a secure location and the resident will only be allowed to smoke when supervised by a responsible individual (i.e , staff member, family, friend) and at the discretion of the organization. Behavior determined to be potentially harmful may jeopardize the person's ability to remain in the health care facility. The facility may exercise its right to involuntarily discharge such individuals. The facility recognizes the potential harm that may result from careless, hazardous smoking and has implemented this policy to maintain a safe living environment. Violation of this policy will be taken seriously, and appropriate action will be forthcoming. 145658 Page 2 of 2