Montana Nursing Home Receives Second ‘Immediate Jeopardy’ Citation Within Two Years
The Montana Department of Public Health and Human Services (DPHHS) conducted an unannounced inspection of a nursing home at the request of the Centers for Medicare & Medicaid Services (CMS). The investigation stemmed from reports by area citizens that a resident in a wheelchair with an oxygen tank attached was frequently seen sitting on the pavement near the curb of a busy street.
Consequently, the facility received an “immediate jeopardy” citation for allowing a resident to be placed in danger of serious harm or death. The facility took immediate corrective steps to prevent the loss of its Medicare and Medicaid funding. The next day the facility submitted, and the state accepted, a plan of correction.
After receiving the first “immediate jeopardy” citation, the facility implemented a non-smoking policy. That citation involved another resident, also in a wheelchair with an oxygen tank attached, who received second degree burns while smoking unsupervised. He died a few weeks later. Soon after that, the facility’s management was taken over by another corporation.
The DPHHS reported that the latest citation involved a resident with fully informed decision-making capability who continued to smoke albeit offsite on the street by the curb. He was repeatedly advised against smoking by facility staff members but would still go out to smoke every 30 minutes to an hour.
On June 6, facility staff reviewed the facility’s no smoking policy with the resident and advised him that he could either transfer to a different facility that would accommodate his smoking, or he could start a stop smoking program aided by the facility and a medical provider. The resident chose not to transfer and to participate in the stop smoking program.
The facility’s plan of correction requires that the resident be closely monitored to ensure that he does not show any signs of smoking and details the action to be taken by the facility should that occur.
Compliance Perspective
Failure to ensure that residents in wheelchairs do not place themselves in danger of serious harm or death by smoking when an oxygen tank is attached to their wheelchair or by locating themselves in unsafe areas may result in immediate jeopardy citations and be considered provision of sub-standard quality of care.
Discussion Points:
- Review policies and procedures regarding the facility’s smoking policy to evaluate whether it adequately addresses situations involving residents using oxygen.
- Train staff about the facility’s smoking policy and the necessity of supervising residents, even if they can leave the facility on their own to go outside and smoke.
- Periodically audit to determine if the facility’s smoking policy is being observed by both staff and residents.
