**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** 4. Resident #48 was admitted to the facility on [DATE] with diagnoses that included but were not limited to: Alzheimer's (1), schizophrenia (2) and depressive disorder (3). The most recent MDS (minimum data set) assessment, a quarterly assessment, with an ARD (assessment reference date) of 9/23/19, coded the resident as scoring a 15 out of 15 on the BIMS (brief interview for mental status) score, indicating the resident was cognitively intact. The resident was coded as independent for bed mobility, transfer, walking in room and corridor, locomotion on and off the unit, dressing, eating, toilet use and personal hygiene. The annual MDS (minimum data set) assessment with ARD (assessment reference date) of 3/23/19 coded the resident's current tobacco use, as yes. The care plan dated 2/6/19, documented in part, Focus: Smoking: Non-compliant with smoking policy. The Goal: dated 2/6/19, documented, (Resident #48) will not smoke against facility policy through next review. The Interventions: dated 2/6/19, documented, Remind her that she cannot smoke under the breezeway close to front doors and remind her that she may only smoke within the designated area on the front SW (south wing) patio and with family. A social service's note dated 2/12/19 at 11:04 AM, documented in part, IDT (inter-disciplinary team) members met to review resident's behaviors of this past week, (Resident #48) smokes, she is aware this is a non-smoking facility and is not to be smoking without a family member or friend accompanying her. She is also aware her family does not want her smoking. Team will continue to monitor. Review of the clinical record failed to evidence any smoking assessment or that Resident #48 had been assessed as safe to smoke unsupervised. On 11/14/19 at 3:45 PM, an interview was conducted, with Resident #48 regarding smoking. Resident #48 stated, I've smoked for about 40 years. I was smoking about 1.5 packs per day; I don't smoke that much now. When asked where she goes to smoke at the facility, Resident #48 stated, I go to the south patio to smoke. When asked if any staff member had discussed smoking with her, Resident #48 stated, Yes, they told me I could only smoke in designated areas off premises. When asked where those areas were located, Resident #48 stated, The far side of the sign and the patio. When asked about the residents smoking materials, Resident #48 stated, I keep the cigarettes, I give them my lighter. When asked if anyone goes out with her to smoke, Resident #48 stated, I sometimes push (Resident #45) out to smoke with me. When asked if staff had assessed her for risks related to smoking, such as fire, Resident #48 stated, Today, but I don't remember before that. On 11/14/19 at 4:10 PM, Resident #48 was observed smoking on the South unit, patio (on the facility premises). There were no staff present, no safety equipment such as a fire blanket or extinguisher and no communication method present during this time. A cigarette disposal unit was observed. An interview was conducted with Resident #48 at this time. When asked where she disposed of the cigarette butt, Resident #48 stated, I put it in the trash can. Resident #48 then placed her cigarette butt in the trashcan, located by the second column from facility front entrance. At this time observation of the trashcan revealed several small black cigarette butt marks on the outer covering. The contents included: a plastic trashcan bag, two cigarette butts, one napkin, one empty plastic water bottle, one small plastic bag, one small water cup, one empty Gold colored Marlboro cigarette pack. A review of the Out on Leave Release of Responsibility of Absence document for Resident # 48 revealed one sign out for each of following months February 2019, March 2019, May 2019, June 2019, July 2019, August 2019 and October 2019; two sign outs for April 2019 and November 2019. In the month of September 2019 there were 25 sign outs to smoke. ASM #1, the administrator, ASM #2, the director of nursing, and ASM #3, the vice president of clinical services, were notified of the above concern during the Immediate Jeopardy on 11/14/19 at 1:56 p.m. References: (1) Alzheimer's Disease is progressive loss of mental ability. This information was obtained from Barron's Dictionary of Medical Terms for the Non-Medical Reader, 7th edition, Rothenberg and [NAME], page 25. (2) Schizophrenia is mental disorder characterized by gross distortions of reality, withdrawal from social contacts, and disturbances of thought, language and perception. Barron's Dictionary of Medical Terms for the Non-Medical Reader, 7th edition, Rothenberg and [NAME], page 518. (3) Depressive disorder is a dejected state of mind with feelings of sadness, discouragement, and hopelessness. Barron's Dictionary of Medical Terms for the Non-Medical Reader, 7th edition, Rothenberg and [NAME], page 157. 3. Resident #95 was admitted to the facility on [DATE], diagnoses include, but are not limited to, COPD (chronic obstructive pulmonary disease) (1), congestive heart failure (2), and high blood pressure. On the most recent MDS (minimum data set), a quarterly assessment with an assessment reference date of 10/27/19, Resident #95 was coded as having no cognitive impairment for making daily decisions, having scored 15 out of 15 on the BIMS (brief interview for mental status). Resident #95 was coded as being independent for transfers, locomotion on and off the unit, dressing, eating, and toileting. The resident was coded as requiring staff assistance for personal hygiene and bathing. Resident #95 was coded as using a walker for mobility and as using oxygen each day during the look back period. During the course of the survey, Resident #95 was observed multiple times (11/14/19 at 4:05 p.m., 11/14/19 at 6:05 p.m., 11/15/19 at 10:15 a.m., and 11/18/19 at 11:25 a.m.). On each of these observations, Resident #95 was observed lying in her bed with oxygen being delivered at 2 lpm (liters per minute) through a nasal cannula. On each observation, Resident #95 was alert and watching television. A review of Resident #95's social services notes revealed the following entries: A note dated 9/10/19, documented, in part: IDT (interdisciplinary team) members met to review residents (sic) behaviors of this past week, resident is aware she lives in a smoke-free facility. She goes outside on front patio and smokes. IDT members will continue to monitor. The social services director, OSM (other staff member) #3, wrote this note. A noted dated 9/17/19, documented, in part: IDT members met to review residents (sic) behaviors of this past week, resident is aware she lives in a smoke-free facility. She continues to go outside north wing entrance to smokes (sic) .IDT members will continue to monitor. The social services director, OSM (other staff member) #3, wrote this note. A note dated 9/25/19, documented, in part: IDT members met to review residents (sic) behaviors of this past week, resident is aware she lives in a smoke-free facility. She continues to go outside north wing entrance to smokes (sic) .IDT members will continue to monitor. The social services director, OSM (other staff member) #3, wrote this note. A note dated 10/1/19, documented, in part: IDT members met to review residents (sic) behaviors of this past week, resident is aware she lives in a smoke-free facility. She continues to go outside north wing entrance to smokes (sic) .IDT members will continue to monitor. The social services director, OSM (other staff member) #3, wrote this note. A note dated 10/2/19, documented, in part: Family Meeting - A family meeting was held this morning with resident's son POA (power of attorney). In attendance was Son, SW (social worker), DON (director of nursing) and UM (unit manager). We discussed with son and she is also being non-compliant with our smoking policy. Son reports this is nothing new for his mother, and that these behaviors have been going on for years due to her depression. We told him that we just wanted to make him aware of the issues The social services assistant, OSM #9, wrote this note. A note dated 10/30/19, documented, in part: Resident reviewed in care plan meeting for a quarterly review. Resident invited during interview and declined. Family invited by mail on 10/2/19 .No one chose to attend at this time. Goals and approaches reviewed. Continue with current plan of care. The social services assistant, OSM #9, wrote this note. A review of Resident #95's comprehensive care plan dated 4/22/19, updated on 9/13/19, and in effect on 11/12/19 when surveyors entered the facility revealed, in part, the following: SMOKER - The resident has a history of smoking. [Resident #95] will not smoke through the review date .Continue to educate and remind resident this is a nonsmoking facility (date initiated 9/13/19). Instruct resident about the facility policy on smoking: no smoking facility .Notify charge nurse immediately if it is suspected resident has violated facility smoking policy. A review of the physician /NP (nurse practitioner) orders for Resident #95 revealed no evidence of information or medications related to smoking or smoking cessation. A review of Resident #95's Leave of Absence Record revealed two entries (5/20/19 at 6:41 p.m. and 5/21/19 at 7:15 p.m.) in which the resident signed herself out. She did not sign herself back in on both dates, and no reason was given for the resident's leave. Further review of Resident #95's clinical record failed to evidence any smoking assessments or that Resident #95, had been assessed as safe to smoke unsupervised prior to survey entrance on 11/12/19. Further review of nurses' notes for Resident #95 revealed no mention of Resident #95's smoking. A review of the physician notes for Resident #95 revealed two notes written by ASM (administrative staff member) #4, the attending physician. ASM #4 wrote notes on 6/30/19 and 9/20/19. On both notes, ASM #4 listed history of tobacco abuse as a problem, but did not mention it in the remainder of either note. A review of the nurse practitioner notes Resident #95 dated 5/29/19,6/3/19, 7/24/19, 7/26/19, 8/7/1/9, 8/12/19, 8/14/19, and 10/4/19 revealed no mention of Resident #95's history of tobacco abuse or smoking at the facility. On 11/14/19 at 9:44 a.m., ASM #2, the director of nursing, was interviewed. ASM #2 stated the facility is a non-smoking facility. When asked what is done to assess residents for safe unsupervised smoking, ASM #2 stated, We don't assesses because we are a non-smoking facility. ASM #2 stated that, to her knowledge, the only place residents could smoke would be off grounds. When asked if a resident who is noncompliant with the non-smoking policy should be care planned for noncompliance, ASM #2 stated, Yes. When asked if Resident #95 is a current smoker, ASM #2 stated, Yes. On 11/14/19 at 10:12 a.m., OSM #3 social services director, was interviewed. OSM #3 stated Resident #95 is noncompliant with the policy. When asked if any residents who smoke also use oxygen, OSM #3 stated that Resident #95 uses oxygen and smokes. When asked if she has provided any education to Resident #95 related to the oxygen use, OSM #3 stated, Yes, they know not to smoke while they are using oxygen. When asked if noncompliant residents are being supervised while they smoke, OSM #3 stated, No. When asked how she knows that Resident #95 is not using oxygen while she is out smoking, OSM #3 did not provide an answer. On 11/14/19 at 11:30 a.m., ASM #1, the administrator, was interviewed. When asked if she is aware that residents are non-compliant with the facility's non-smoking policy, ASM #1 stated, Yes. On 11/14/19 at 4:05 p.m., Resident #95 was interviewed. When asked if she smokes at the facility, Resident #95 stated, Yes. Not every day, but most days. When asked where she goes to smoke, Resident #95 stated, I go outside those doors there [pointing to the doors near the nurse station]. When asked if she goes off the facility property, Resident #95 stated, No, I just go down the sidewalk a little bit. When asked if she does anything with her oxygen while smoking, Resident #95 stated, Oh, I take it off. It never leaves the room with me. Resident #95 stated she ambulates independently with her walker, and that no one accompanies her. Resident #95 further stated, I don't need anybody. It's not too far to walk. When asked if there was a cigarette disposal device where she had been smoking, Resident #95 stated, No. When asked how long she has been smoking at the facility, Resident #95 stated, Ever since I got here. But I only got caught doing it a little while ago. When asked where her smoking materials are kept, Resident #95 stated, They are right there [pointing a bag hanging on her walker]. When asked if she had both her cigarettes and lighter in her room in the bag, Resident #95 stated, Yes. At this time, the surveyor approached LPN (licensed practical nurse) #10 and informed her that Resident #95 had reported that she has both cigarettes and a lighter in her room, where there is also an oxygen concentrator. LPN #10 stated, She is not allowed to have her lighter. I will go get it. On 11/14/19 at 6:11 p.m., an interview was conducted with LPN #10 to verify that Resident #95's lighter was no longer in the room with the oxygen concentrator. LPN #10 showed the surveyor the lighter, and stated, She [Resident #95] gave it up easily. She knew she was not supposed to have it in there with her. LPN #10 was asked when she became aware that Resident #95 was smoking on facility premises. LPN #10 stated, I'm not even sure. Not too long ago. It seems like everybody just knew it. When asked if she reported the smoking to anyone, LPN #10 stated, I'm pretty sure I told the social worker. On 11/18/19 at 10:19 a.m., OSM #9, the social services assistant was interviewed. When asked when she became aware that Resident #95 was smoking outside on the facility premises, OSM #9, stated, I was not aware until somebody told me they had seen her outside smoking, maybe two months ago. I called her son to find out if they were bringing her cigarettes, and he said no. He said she had been a smoker at the assisted living where she lived before this nursing home. He said he had no idea how she was getting her cigarettes. When I found out she (Resident #95) was smoking, I asked her to give me the cigarettes and the lighter. She gave them to me without any trouble. She would typically smoke before I get here or after I leave. My understanding is that she would go outside, down the sidewalk a little ways. When asked if that location was considered to be off facility property, OSM #9 stated, No. She further stated, She [Resident #95] is a night owl. She stays up all night and sleeps during the day. OSM #9 stated the administrator and all the department heads are aware that Resident #95 has been smoking. OSM #9 stated this concern was brought up at the daily morning meeting on several occasions. When asked if the attending physician or NP (nurse practitioner) are aware of the smoking, OSM #9 stated, They are both aware. On 11/18/19, an interview was conducted with OSM #3, at 10:43 a.m. OSM #3 stated that OSM #9, (the social services assistant) was the social worker responsible for Resident #95's unit and that she (OSM #3) attends the IDT meetings and documents those. OSM #3 stated she became aware that Resident #95 was smoking at the facility by going to the north end patio to smoke. She stated, as far as she knew, Resident #95 had never gone off the property to smoke. On 11/18/19 at 11:23 a.m., ASM #4, the attending physician, was interviewed. When asked if he was aware that Resident #95 had been smoking at the facility prior to surveyor entrance on 11/12/19, ASM #4 stated, I don't remember specifically what I knew. On 11/18/19 at 11:49 a.m., ASM #6, the NP (nurse practitioner) was interviewed. When asked if she was aware that Resident #95 had been smoking at the facility, ASM #6 stated, Yes. I have been aware, but I've actually never seen her smoke. ASM #1, the administrator, ASM #2, the director of nursing, and ASM #3, the vice president of clinical services, were notified of the above concern during the Immediate Jeopardy on 11/14/19 at 1:56 p.m. References: (1) COPD is a general term for chronic, nonreversible lung disease that is usually a combination of emphysema and chronic bronchitis. Barron's Dictionary of Medical Terms for the Non-Medical Reader, 5th edition, Rothenberg and [NAME], page 124. (2) Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptoms to occur throughout the body .As the heart's pumping becomes less effective, blood may back up in other areas of the body. Fluid may build up in the lungs, liver, gastrointestinal tract, and the arms and legs. This is called congestive heart failure. This information is taken from the website https://medlineplus.gov/ency/article/000158.htm Based on observation, staff, interview, resident interview, facility document review, and clinical record review, facility staff failed to ensure six of 60 sampled residents, (Residents #32, #36, #45, #95, #48, and #101) were assessed and safe, for unsupervised smoking, to prevent accidents and injuries, and failed to ensure a safe environment for smoking residents, and others residing in the facility. On 11/12/19, during entrance, the facility administrator, ASM (administrative staff member) #1 stated the facility was a nonsmoking facility and presented the policy. On 11/14/19 at 9:14 a.m., Resident #32 and 36 were observed outside on the south unit, patio (on the facility premises) smoking, without staff supervision. The patio area had no receptacles to safely, extinguish and dispose of cigarettes, or safety equipment (fire extinguishers, fire blankets, etc.). The clinical records for both residents documented noncompliant smoking behaviors, but failed to evidence either resident had been assessed, as safe to smoke unsupervised. On 11/14/19, Residents #45, #95, #48, and #101, were identified as residents who smoke on a list provided by ASM #1, the administrator. Each resident had documented noncompliant smoking behaviors and the facility staff stated they were aware. The clinical records for Residents #45, #95, #48, and #101, failed to evidence they had smoking assessment completed or had been assessed as safe to smoke unsupervised. This resulted in Immediate Jeopardy (IJ) and SQC (substandard quality of care), which was identified in the area of Quality of Care on 11/14/19 at 1:56 p.m. The plan of removal for the immediacy was accepted on 11/14/19, at 7:30 p.m. The IJ was abated on 11/15/19 at 10:40 a.m., with the Scope and Severity lowered to Level II, Pattern. The findings Include: Surveyor A: 1. On 11/12/19 at 11:30 a.m., during the entrance conference, the ASM (administrative staff member) #1, the administrator stated that the facility is a non-smoking facility and provided the facility policy asserting the facility's non-smoking status. A review of the facility policy, documented the following: It is the policy of (name of facility) to be a non- smoking facility for residents. This smoke-free environment is to ensure that the environment exists from threat of Fire and of primary and secondary smoke. No Smoking will not be allowed inside the facility at any time. We do recognize that a resident has the right to smoke and this will be allowed, however they must go off campus. Their lighters must be kept at nurses' station and they must return them after they are finished smoking. The designated area for Visitors is outside at the front porch marked off with yellow tape. Staff members who smoke will only be allowed to smoke outside off the loading dock in the space provided. (Note - a tour of the facility, discussed in a later paragraph, revealed there was no area marked off with yellow tape.) This policy was noted as Revised October 2019. On 11/14/19 at 9:15 AM, an observation was made of the South unit, patio area by bending down to look through one of three windows with blinds. The window the observation was conducted through had blinds closed 3/4 the way and revealed two residents [Resident #36 and #32] smoking on the south unit patio (on facility property). Resident #36 was sitting in a chair on the patio alongside Resident #32. Both residents were observed smoking. No staff members were assisting the residents. No safety devices such as a fire extinguisher or smoking aprons were observed in the smoking area. There were no cigarette disposal devices to safely extinguish and dispose of cigarettes. The inside of the building at this patio was the south unit living room / dayroom / dining area. There were three large windows located on the end wall of the building that faced this patio area. Two of the windows hand blinds closed all the way. The third window through which the observation was conducted had the blinds closed 3/4 of the way down. There were two doors, observed that led out from either side of the living room / dayroom / dining area. One door on the left and one on the right side, close to the large windows. Both doors required a keypad code to exit the building. The two residents who were smoking on the patio were not visible through the windows with the blinds all the way down. On one side of the living room / dayroom / dining area, at the last resident room, closest to the windows, LPN (licensed practical nurse) #8 was observed at a medication cart. When asked whom the two residents were outside on the patio, LPN #8 went over to the window through which the observation was made, and moved the blind to the side to see the residents. LPN #8 identified the residents that were smoking as Residents #32 and #36. There was no other staff noted in the area inside or outside of the building supervising the two residents. On 11/14/19 at 9:17 AM in an interview with CNA #3 (Certified Nursing Assistant), she was asked if the residents were allowed to smoke there. CNA #3 stated, I honestly don't know. On 11/14/19 at 9:44 AM, in an interview with ASM #2 (Administrative Staff Member, the Director of Nursing), ASM #2 stated, This is a non-smoking facility. It was non-smoking before I got here. I started June, 2018. When asked about assessing the residents for safe smoking, ASM #2 stated, We don't assess them because we are a non-smoking facility. When asked about the location of where residents, are instructed to smoke, ASM #2 stated, The sign (the property entrance sign that identifies the name of the facility located at the entrance to the parking lot) is off grounds. That is off-site for smoking for (name of facility). (Note: This sign is located in a mulched roundabout area where the street meets the parking lot. The street extends off the main road and goes up hill towards this mulched area marking the entrance to the facility parking lot) When asked if that is the only place, the residents can smoke, ASM #2 stated, Yes, to my knowledge. When asked if she had seen residents smoke elsewhere, ASM #2 stated, No. When asked if residents were assessed to determine if they were safe to smoke in these areas, ASM #2 stated, No because it is non-smoking facility. When asked about residents who smoke at the facility, ASM #2 stated, That I'm aware of, maybe five, (she then named the residents, including Resident #32 and #36). ASM #2 was asked when the facility was aware the residents were smokers. ASM #2 stated, I knew they were (smokers) before today. When asked if residents who are smoking should be, care planned, ASM #2 stated, Yes. Whenever we realize they are a smoker. When asked further about the care plans, as reviews had revealed the care plans were developed and/or reviewed/revised on this date (11/14/19), ASM #2 stated, I did the care plans this morning, I won't lie to you. I was told you (surveyors) were looking at smokers. When asked who updated the care plans, ASM #2 stated, I updated all of them. When asked who should have updated them before this date, ASM #2 stated, I thought social services would have updated the care plan. When asked if the facility has IDT (Interdisciplinary team) meetings, ASM #2 stated, Yes, I don't attend the meetings. When asked if the facility has weekly care plan meetings, ASM #2 stated, Yes, if they are not complying (with no smoking) we talk about it as a behavior. To my knowledge this is a non-smoking facility. Resident #32's diagnoses include but are not limited to, stroke with hemiplegia, and seizure disorder. The most recent MDS, an annual assessment, with an assessment reference date coded the resident as scoring a 12 on the BIMS (brief interview for mental status) score, indicating the resident was moderately impaired to make daily cognitive decisions. The resident was coded as requiring extensive assistance of one staff member for bed mobility, transfers, dressing, and bathing. He required limited assistance of one staff member for toileting and personal hygiene. In Section G - Functional Status, the resident was coded as having impairments in his range of motion in his arm and leg on one side. Resident #32 was coded as being independent in moving on and off the unit with only set up assistance. The resident was coded as using a wheelchair for his locomotion. Under J1300, he was coded, no for tobacco use. A physician's order dated 4/3/19, documented, Nicotine Patch 14 mg (milligrams) daily for 2 weeks, and then decrease to 7 mg daily for 2 weeks and then discontinue. A review of the April 2019 MAR (Medication Administration Record) revealed that the patch was provided. The comprehensive care plan dated 3/3/17 documented, Behaviors: (Resident #32) is aware this is a non smoking (Sic.) facility. The interventions included, 3/3/17 - Encourage pt (patient) not to smoke or ask visitors for cigarettes due to no smoking policy. 3/3/17 - Encourage (Resident #32) to not get cigarettes out of ashtrays out side (Sic.). 3/3/17 - Review smoking policy with resident as needed. There were no other interventions prior to the survey, for smoking. Further review of 6 months of notes in the clinical record revealed the following notes documented by the social worker: On 5/7/19, 5/14/19, 5/21/19, 5/28/19, 6/4/19, 6/18/19, 7/2/19, 7/12/19, 7/16/19, 7/30/19, 8/6/19, 8/14/19, and 8/26/19, that documented, (Resident #32) smokes when (Resident #32) knows a family member or friend must be with (Resident #32). (Resident #32) is wearing a nicotine patch, but continues to sneak smoke (Note the physician order for the patch was during the month of April. There were no nicotine patch orders in place and no nicotine patch provided for the above identified dates.) On 9/4/19 the following was documented, (Name of Resident #32) smokes when (Name of Resident #32) knows a family member or friend must be with (Name of Resident #32). (Name of Resident #32) is giving other residents cigarettes. (Name of Resident #32) has been educated. Denies this behavior On 9/17/19, 9/25/19, and 10//1/19 the following was documented, (Name of Resident #32) continues to smoke when (Name of Resident #32) has been educated on smoking policies. (Name of Resident #32) is providing cigarettes to other residents in the facility, and denies behaviors when questioned On 10/22/19, the following was documented, Resident continues to smoke when (Name of Resident #32) has been educated on smoking policies. Resident is providing cigarettes to other residents in the facility, and denies giving other residents cigarettes. Resident picking up cigarette butts in the parking lot to smoke. Resident denies this behavior On 11/7/19, the following was documented, resident continues to smoke when (Name of Resident #32) has been educated on smoking policies. (Name of Resident #32) is providing cigarettes to other residents in the facility, and denies behaviors when questioned. Resident also is picking up cigarette butts in the parking lot Review of the clinical record failed to evidence any smoking assessments for safe unsupervised smoking or any other interventions to address the residents continued smoking other than what is documented above. Surveyor B clinical record review of Resident #36 and interview: Resident #36, was admitted [DATE], diagnoses included but are not limited to, dementia, epilepsy (seizure disorder), and unsteadiness on feet. Resident #36's admission MDS (minimum data set) assessment with an ARD (assessment reference date) of 03/01/2019, scored Resident #36 at a 14 on the BIMS (brief interview for mental status), indicating minimal impairment. Resident #36 was coded as requiring supervision of one staff member for most ADLs (activities of daily living). Under J1900. Number of falls since admission or prior assessment, whichever is most recent, Resident #36 was coded with a 1 under: B. Injury (except Major) skin tears, abrasion, laceration, superficial bruises, hematomas, and sprains; or any fall -related injury that causes the resident to complain of pain. Resident #36's mobility device was coded as a walker. Resident #36's care plan documented interventions for the behavior of smoking as follows: Instruct Resident about smoking risks and hazards and about smoking cessation aids that are available, notify charge nurse immediately if it is suspected that resident has violated facility smoking policy (Non Smoking facility). These interventions were dated Initiated 02/22/2019 and Revised 02/26/2019. On 11/14/2019 at 12:00p.m., an interview was conducted with Resident #36 regarding his smoking habits at the facility. During this interview, Resident #36 stated that on one occasion he fell while ambulating himself to the spot staff had directed him to smoke, which was a mulch-covered area near the facility signage (the property entrance sign that identifies the name of the facility located at the entrance to the parking lot). Resident #36 stated that he became weak and just sort of sat down suddenly. When asked how he got back, Resident #36 stated that another resident who was out to smoke, Resident #32 who uses a wheelchair, had to wheel back to the facility and get staff for assistance. A review of Resident #36's medical record verified documentation of a fall without injury occurring on 09/04/2019. An entry dated 10/02/2019, documented IDT (interdisciplinary team) met to review fall when legs became weak while walking and he fell. Will continue on therapy caseload and no other falls have been reported. Team will continue to monitor. Resident #36's medical record, failed to evidence a smoking assessment to determine safety smoking and with unsupervised smoking. Surveyor A: On 11/14/19 at 10:12 AM, an interview was conducted with OSM #3 (Other Staff Member, Director of Social Services), regarding residents that smoked. OSM #3 stated, Usually, if I find out they are smoking, I have to tell them it is a non-smoking facility, which they already know. When asked what that means, OSM #3 stated, Not to smoke on the grounds. When asked about the location residents are allowed to smoke, OSM #3 stated, Past the [TRUNCATED]