Health inspection·July 11, 2019

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. Based on interview, observation, and record review the facility failed to ensure a resident was supervised while smoking and that he did not have smoking material including cigarettes and lighter on his person per his smoking assessment and care plan. This affected one resident (Resident #5) of twelve residents identified as smoking residents residing at the facility. Findings include: Record review for Resident #5 revealed an admission date of 07/28/18 and diagnoses included alcohol abuse, cannabis abuse, abuse of non-psychoactive substances, and schizophrenia. Review of care plan dated 07/30/18 for Resident #5 revealed he had health risks related to smoking. Interventions included staff were always to provide supervision for smoking and smoking items were to be kept at the nursing station. Review of quarterly Minimum Data Set (MDS) for Resident #5 dated 04/08/19 revealed he had cognitive impairments as his Brief Interview for Mental Status (BIMS) score was a ten. Review of smoking assessment labeled, Smoking Data dated 07/09/19 for Resident #5 revealed staff were to observe the resident while smoking as all residents would be supervised while smoking regardless of their capabilities. He required no appliances or assistance while smoking. Interview on 07/09/19 at 2:16 P.M. with State Tested Nursing Assistant (STNA) #601 revealed all residents were to be supervised to smoke and no residents, per policy, can have cigarettes or lighters on them as they had to be stored in the nursing station. She revealed staff had to light all cigarettes for the residents when they are smoking. She revealed Resident #5 had to sign out in the leave of absence book and go to the new patio the facility recently built off the path if he wanted to smoke unsupervised outside of smoking times. Interview on 07/09/19 at 4:10 P.M. with Licensed Practical Nurse (LPN) #603 revealed all residents were to be supervised when smoking and were not to keep cigarettes or lighters on them as smoking materials were stored at the nursing station. She revealed if Resident #5 wanted to smoke in between smoking times he had to sign out on leave of absence and go to a patio off the path to smoke. She revealed he then was not supervised. Interview on 07/09/19 at 4:20 P.M. with Resident #5 revealed he goes a few times a day to the new outside patio the facility just built to smoke which was located down the path. Resident #5 revealed he does not need to be supervised while smoking and can go anytime throughout the day. Page 1 of 2 365638 365638 07/11/2019 Jefferson Healthcare Center 222 E Beech St Jefferson, OH 44047

F 0689 Level of Harm - Minimal harm or potential for actual harm Interview on 07/09/19 at 4:28 P.M. with the Maintenance Director #600 revealed he recently built the new patio located next to the paved path going around the facility. He revealed the patio was considered off facility property as technically the owner owns the property but was not part of the facility's property where the new patio was built. He revealed the residents use this area for smoking, but the residents had to sign out by leave of absence to be able to use the area unsupervised. Residents Affected - Few Interview on 07/09/19 at 5:55 P.M. with the Administrator and Director of Nursing revealed in the past when the residents wanted to smoke outside of smoking times they signed out by leave of absence and went across the street off facility property to smoke. They revealed they felt this was a safety concern and recently the facility decided to have a cemented area with a picnic area built next to the path. They revealed this area was off facility property. They revealed all residents including Resident #5 was to be supervised while in the facility and no residents were to have smoking material on their person. Observation on 07/10/19 at 8:35 A.M. of Resident #5 revealed he opened the gait to the gazebo area and propelled in his wheelchair down the path to the newly cemented area. He then lit a cigarette that he pulled from a cigarettes case out of his pocket. No staff were in the area while he was smoking. Interview on 07/10/19 at 8:37 A.M. with STNA #602 verified Resident #5 was smoking unsupervised on the patio next to the paved path by the facility. She verified he had a lighter and four remaining cigarettes in a case on his person. Interview on 07/10/19 at 8:39 A.M. with LPN #603 verified she was Resident #5's nurse and he did not sign out in the leave of absence book and she verified he was to be supervised when he smokes at the facility. She verified that residents were not to have cigarettes or lighters on them per their facility policy. Review of undated form labeled, Release of Responsibility for Leave of Absence, for Resident #5 revealed he did not sign out on 07/10/19 at 8:35 A.M. when he went to smoke. Review of facility policy dated 07/17/18 labeled, Resident Smoking, revealed all residents would be supervised while smoking, and staff would light all smoking products. The policy revealed all smoking materials would be kept in a secured area and distributed by the facility staff and a resident would not be permitted to carry or have in their possession smoking material including cigarettes or lighters. The policy did not include residents signing out on leave of absence to smoke. 365638 Page 2 of 2