**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review, the facility failed to identify avoidable accident hazards during a mechanical lift transfer for 1 of 3 residents (Resident 1) reviewed for falls. Resident 1 experienced harm when they fell to the floor from the mechanical lift and sustained a hematoma (a collection of blood that forms outside of blood vessels, usually caused by an injury or trauma) and an abrasion to the forehead, requiring a transfer to the emergency room. Findings included . Review of a policy titled, Limited Lift Program (Safe Patient Handling), revised 09/19/2024, showed the facility would provide education upon hire and annually to staff on proper use of mechanical lifts in accordance with the manufacturer's guidelines. The education would also include the need to have two staff members present during the transfer. Additionally, manufacturer guidelines would be used to determine the type and size of sling that should be utilized when a lifting device was required. Review of the facility provided manufacturer's instructions for use for a Vive Healthcare Patient Lift Sling (the sling used with Resident 1 on 09/19/2024), received by the facility via email on 09/20/2024 at 2:06 PM, showed the sling was compatible with most floor lift models. Review of the Joerns Hoyer Lift (Hoyer HPL700 - used with Resident 1 on 09/19/2024) manufacturer's user instruction manual, dated 2024, showed the Hoyer HPL700 lift .is designed to be used in conjunction with the Hoyer range of slings. Additionally, there were several warnings regarding sling use, including: Hoyer recommends the use of genuine Hoyer parts. Hoyer slings and lifts are not designed to be interchangeable with other manufacturer's products. Using other manufacturer's products on Hoyer products is potentially unsafe and could result in serious injury to patient and/or caregiver. <Resident 1> Review of the medical record showed Resident 1 was admitted to the facility with diagnoses of a stroke with left arm paralysis (loss of muscle function), muscle weakness, and heart failure. The 07/24/2024 comprehensive assessment showed Resident 1 was dependent on two staff members for bed mobility (the ability to move in bed) and transfers between surfaces. The assessment also showed Resident 1 had an intact cognition. Review of Resident 1's care plan, dated 07/31/2024, showed the resident required two-person assistance for transfers with a Hoyer Lift (a mechanical lift used to transfer a resident between two surfaces) and bed mobility. Review of a facility investigation report showed on 09/19/2024 at 7:04 AM, Resident 1 was transferred from their bed to their wheelchair using the Hoyer Lift. The investigation showed the interdisciplinary team (a group healthcare professionals from different disciplines to help people receive the care they need) had established the mechanical lift sling had not been hooked appropriately to the Hoyer Lift which caused the strap to slide off, causing Resident 1 to fall out of the sling onto the floor. Resident 1's head hit the floor, and their right shin hit the edge of the Hoyer Lift. Resident 1 was moved from a face down position to a seated position on the floor. The resident was noted to have a hematoma to the head and complained of leg pain. Review of hospital records, dated 09/19/2024, showed Resident 1 had arrived at the emergency room for evaluation of injuries after falling out of a Hoyer Lift and hitting their head on the floor. Resident 1 was noted to have a large forehead contusion (a type of hematoma of tissue, damaged by trauma, causing localized bleeding that spreads into surrounding tissues) and was taking a blood thinner. Review of a written statement by Staff B, Nursing Assistant (NA), dated 09/19/2024 at 7:15 AM, showed Staff B hooked up (attached the sling loops to the Hoyer Lift hooks) Resident 1 to the Hoyer Lift and was in control of the Hoyer Lift. Staff C, NA, guided the resident to position them into their wheelchair. Staff B proceeded to lower Resident 1 into the wheelchair; next thing we knew, client (Resident 1) is on the floor. Review of a written statement by Staff C, dated 09/19/2024, showed Staff C had answered a call on their radio requesting assistance with a transfer. When Staff C entered Resident 1's room, the resident was already hooked up to the Hoyer Lift. Staff B and Staff C lifted the resident with the Hoyer Lift, while Staff C guided the resident's feet, Staff B opened the legs to the Hoyer Lift. Staff C placed Resident 1's wheelchair in place, and just as doing so, one of the sling straps slipped and the resident fell out of the sling onto their face. Review of a written statement by Staff D, NA, dated 09/19/2024, showed Staff D had responded to a call on the radio that there was a fall in Resident 1's room. They ran to the room and saw Resident 1 face down on the Hoyer Lift legs and floor. One strap of the sling was hanging on the lift, not connected. A concurrent observation and interview on 10/01/2024 at 3:47 PM, showed Resident 1 sitting in their room in their wheelchair. They had a large hematoma measuring 5.2 centimeters [(cm) a unit of measurement) by 6.1 cm on their forehead with a pea sized scab in the center of the hematoma. Resident 1 had significant faded purple/yellow facial bruising surrounding each eye, along the left cheek bone, and deep purple bruising measuring 5.1 cm by 11.0 cm on their neck. When asked if they felt they had a significant injury due to the fall, Resident 1 stated yes, I face planted out of the lift and had a CT scan [computed tomography (CT) - an imaging technique used to obtain detailed internal images of the body]. Resident 1 stated they were unable to remember if the sling had been attached to the lift correctly. During an interview on 10/01/2024 at 4:26 PM, Staff C stated Resident 1 was already hooked up to the Hoyer Lift when they went into their room to assist with the transfer. Staff C stated just as they went to grab onto Resident 1 to position them in their wheelchair, one of the sling straps (the leg strap) had slipped off the Hoyer Lift and Resident 1 fell off the sling. Staff C stated Staff B had strapped the resident to the Hoyer Lift before they entered the room; they were just assisting with the transfer. Staff C stated they had received safe Hoyer Lift training upon hire and right after the fall. Staff C stated they were instructed on how to hook up the sling and safely transfer a resident. They stated they were also trained to make sure the sling they were using matched the mechanical, but I don't know exactly which lift goes with which sling. During a follow-up interview on 10/03/2024 at 1:02 PM, Staff C stated they did not double check the straps on the sling prior to lifting Resident 1. Staff C stated they had not used the flat sling prior to using it to transfer Resident 1 and had not received any training on the use of that sling. Staff C stated they were hurrying that morning and did not double check the hooks for safety and I should have. During an interview on 10/01/2024 at 4:45 PM, Staff E, Licensed Practical Nurse, stated they had performed an assessment on Resident 1 after the fall on 09/19/2024. They stated when they entered the room, the sling was still hanging from the mechanical lift with three points of contact, not four points of contact. Staff E stated it looked like the sling had not been hooked up properly. They stated the sling they used was different than the normal slings. Staff E stated they had questioned the use of the sling but was told it was ok to use. Staff E stated they did not know where that particular sling came from and were unsure why staff had chosen to use that sling. During a concurrent observation and interview on 10/01/2024 at 5:20 PM, Staff A obtained a mechanical lift sling from a locked closet and stated that was the sling that was in use when Resident 1 fell on [DATE]. Observation of the sling showed a flat sling with four straps; each strap had four loops for attaching to the mechanical lift. There was no manufacturer identification on the sling. Staff A stated the sling had been donated by a family and going forward, the facility would use the sling for smaller residents because the sling was too small for the resident it was used on. Staff A provided the package insert/documentation that was in the bag with the sling. During an interview on 10/03/2024 at 12:11 PM, Staff B stated their normal process for using the Hoyer Lift was to call for a second person to help with the transfer. They stated they normally wait for the second person before hooking up the sling to the Hoyer Lift. Staff B stated the morning of 09/19/2024, they asked for assistance with the transfer over the radio. Staff B stated they made a mistake by hooking up Resident 1 prior to the second staff member coming into the room. Staff B stated Resident 1 asked if they were secure on the Hoyer Lift prior to lifting them, and both Staff B and Staff C assured Resident 1 they were secure. Staff B stated they remembered attaching all four straps to the Hoyer Lift and checking them to make sure they were on correctly. Staff B stated they proceeded to lift Resident 1 with the Hoyer Lift, and the strap came off the hook. Resident 1 had fallen on their front side and had a little cut on their forehead. Staff B stated they were very confused as they remember checking the straps before lifting the resident. They stated the sling they used that morning to transfer Resident 1 was the sling that had been assigned to the resident on the day they were admitted . Staff B stated they had not seen or used that sling prior to using it with Resident 1. They stated the sling was a full body, flat sling that did not have the cross straps for the legs. Staff B stated they had not been trained on the use of that type of sling. Staff B stated after the incident, they were pulled from the floor and sent home pending an investigation and had to demonstrate proper use of the sling prior to returning to work. Staff B stated after the fall, Resident 1 complained of a headache and was sent to the emergency room. During an interview on 10/03/2024 at 10:28 AM, Staff A, Director of Nursing Services, stated they had read the manufacturer's guidelines for use of the sling prior to putting it into service. During a follow-up interview that same day at 1:39 PM, Staff A stated the nursing assistants received mechanical lift training during their orientation and annual competency's. They stated Staff B needed more training, a refresher, because they only worked as needed and Staff B was just moving too fast that morning. Staff A stated the process for transferring a resident with a Hoyer Lift included two staff members, and they should always check the straps prior to lifting the resident. Staff A stated they did not provide training on that particular sling before putting it into use. They stated they felt staff would know how to use the sling and would not require additional training on the proper use of the flat sling. Staff A stated during the transfer of Resident 1 on 09/19/2024, one strap of the sling fell off during the resident's transfer and they were not sure why it fell off. Staff A further stated they checked the manufacturer's guidelines for the sling but did not check the manufacturer's guidelines for the Hoyer Lift to ensure they were safe to use together. Reference (WAC) 388-97-1060(3)(g)

**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview and record review, the facility failed to ensure a resident was treated with dignity/respect in a manner that promoted the resident's choice to smoke independently without fear of intimidation or reprisal (an act of retaliation) for 1 of 2 residents (Resident 33), reviewed for the resident right to smoke cigarettes independently. Additionally, the facility failed to protect Resident 33 from ongoing staff reproach (the expression of disapproval or disappointment) when Resident 33 exercised their right to smoke cigarettes outside facility grounds. This failed practice of the violation of Resident 33's right to a respectful and dignified existence resulted in psychosocial harm to the resident who described they experienced feelings of humiliation, distress, frustration, harassment, anger, increased sadness, and were at risk for a diminishment of self-worth when choosing to smoke. Findings included . Review of the facility's policy titled, Non-Smoking Facility, revised 08/09/2022, showed the purpose of the policy was, To protect the public health and welfare by prohibiting smoking in the enclosed areas that make up the Nursing Home and on the other grounds of the Nursing Home. The policy further showed, Smoking is not allowed, at any time, inside or outside the building or on the property by residents, staff, or visitors ., that all staff would be provided education on the facility's smoking policy, and .upon identification of smoking non-compliance by resident family or visitors, staff will intervene immediately, providing instruction on the facility's non-smoking policy . Review of the facility's admissions documents (paperwork reviewed with the resident on admission to the facility) titled, Smoking Policy Communication, undated, showed The facility strives to provide a safe environment for resident who smoke tobacco products . Additionally, the communication stated that residents were not permitted to have any smoking paraphernalia (i.e. cigarettes, e-cigarette, vaping devices, lighters, matches, etc.) in their possession at any time during their stay. Furthermore, the facility's smoking policy communications stated that if the resident was non-compliant (not following the smoking rules) with the facility's smoking policy that it may result in the resident being involuntary discharged . Resident 33. Review of Resident 33's electronic medical records (EMR) showed they were admitted on [DATE] from the hospital after they had a fall with a diagnosis of long-term lower right and left leg wounds, anxiety (the mind and body's reaction to stressful, dangerous, or unfamiliar situations), depression, and nicotine dependence. Review of Resident 33's comprehensive assessment, dated 06/01/2023, showed the resident was alert, cognitively intact, able to make their needs known, was easily understood by staff, needed extensive assistance with transferring, needed supervision with moving around in a wheelchair, and was a current user of tobacco products, and was currently still smoking off the property. The assessment further showed the resident was not taking any medications for their anxiety or depression. Review of Resident 33's history and physical from their hospitalization, dated 05/16/2023, showed that the resident was currently smoking cigarettes and had been smoking for the past 43 years. Record review of a smoking safety evaluation completed by the facility the day after Resident 33's admission, dated 05/26/2023 at 8:44 AM, showed Resident 33 had not attempted to keep smoking paraphernalia on their person or in their room, was following the smoking regulations of the facility and had demonstrated the ability to safely smoke with supervision. It was also noted that Resident 33 declined different alternatives offered by the facility, to quit smoking (such as a nicotine patch - a product that can help residents to quit smoking). Review of Resident 33's plan of care, dated 06/04/2023, showed the resident was an active smoker and the facility's goal for the resident was .will have no complication related to desire to smoke. During a concurrent observation and interview on 06/21/2023 at 4:08 PM, showed Resident 33 seated slumped over, reddened face, darkenned and sunken area of skin under their eyes with tears swelling up in their eyes and the corners of their mouth were turned downwards (frowning) when they talked about what they believed to be the continuous beratement (to be spoken to angril about something that was done wrong) that had occurred by facility staff for their choice to continue to smoke since the day of admission. The resident stated that they went from going just outside of the nursing home (since admission) to now smoking cigarettes off of the facility's property on the sidewalk, but felt they were constantly getting reprimanded (to tell someone officially that they had done something wrong) and harassed (subject to abusive pressure or intimidation) by facility staff. The resident stated that Staff F, Maintenance Director, and Staff C, Social Service Director (SSD), met with the resident on 06/19/2023 about their smoking even though they were smoking on the sidewalk (which is considered public property and off of the facility's property). The resident stated that both Staff F and Staff C came to their room and accused the resident of hiding smoking paraphernalia within their room, I told them that I had not been hiding the cigarettes in my room, that I had been smoking on the sidewalk and that I stashed (to store something safely and secretly in a specific place) my cigarettes and lighter in the bushes by the sidewalk. When Resident 33 was asked why they stashed their cigarettes/lighter in a bush, they explained it was because facility staff took their smoking paraphernalia the day they were admitted , and again a week ago after the facility staff saw the resident smoking outside on the sidewalk. The resident explained they did not have any other way to store their smoking paraphernalia since the facility staff would not give them their cigarettes/lighter when they went outside to smoke and facility staff informed the resident they could not have their smoking paraphernalia back until they were discharged from the facility. Resident 33 pointed from their room window to a spot across the parking lot 50 feet (measured by heel-to-toe steps with the Surveyors 12 inch foot) away next to the public sidewalk, where they stashed their cigarettes and lighter in a bush that was no longer there. The resident continued to explain her perception of the facility's recent actions. I mean (Staff F) tore out a bush to get back at me for smoking! Who does that? (tears rolling down Resident 33's cheek, lips trembling, with a confused look on their face). Review of Resident 33's Social Service Assessment, completed 06/05/2023, showed the resident's mood and behavior status as anxious, the resident would become upset quickly, and they wre upset about the smoking regulations. The policy had been discussed with the resident. Review of Resident 33's progress notes for May and June 2023 showed: • 05/25/2023 at 3:35 PM, Staff C documented the resident was on the sidewalk smoking and Staff C discussed with the resident as the facility was non-smoking. Resident 33 was offered a nicotine patch, and they declined wanting the nicotine patch. • 05/25/2023 at 5:11 PM, Staff D, Social Service Assistant (SSA), .confiscated (to take away as punishment or to enforce the law or rules) cigarettes and lighter and stored them away until resident is ready to leave facility. • 05/31/2023 at 9:01 AM, Staff D documented that SSA was pulled out to the parking lot due to Resident 33 smoking a cigarette. Resident 33 stated they were out on the sidewalk (off the facility property) and could smoke. SSA stated as long as Resident 33 was at this facility they were not allowed to smoke. Resident 33 seemed annoyed and stated they would be calling their family. SSA explained again that as long as Resident 33 was a resident at the facility, there were not allowed to smoke. • 05/31/2023 at 12:46 PM, Staff C documented, Resident very teary during initial discharge planning evaluation assessment .has not adjusted well due to not being able to smoke .smoking policy discussed with resident as (Resident 33) continues to want to smoke. Policy reviewed with resident and Social Services Director asked resident to sign smoking policy communication. Resident refused. • 06/01/2023 at 1:32 PM, care management note showed Resident 33's goal to discharge home with home health. • 06/08/2023 at 1:06 PM, care management note showed Resident 33 reported that they were homeless. • 06/13/2023 at 5:14 PM, Staff C and Staff E, Licensed Practical Nurse (LPN), showed that both staff discussed with Resident 33 that they could not smoke on facility grounds and needed to turn in their cigarettes. Resident 33 informed both staff that they were smoking on the sidewalk. Staff asked the resident to turn in their cigarettes, and two packs of cigarettes and a lighter were turned in to the Director of Nursing Services (DNS). • 06/19/2023 at 3:45 PM, Staff C documented they met with the resident in order to discuss concerns with smoking within facility grounds over the weekend. The resident denied the allegations and stated they did not have cigarettes in their room. Resident 33 stated they had cigarettes stashed outside of the facility grounds. The resident was reminded of the facility's non smoking policy. During a concurrent observation and interview on 06/22/2023 at 4:04 PM, Resident 33 stated that since the bush was torn out, they stashed their cigarettes andlighter with a neighbor that had a house right next to the nursing facility. Resident 33 stated that staff confiscated all the other cigarettes they had. The resident stated that even this morning when they signed out to go smoke outside they were told by Staff B, DNS, that the facility was a non-smoking facility, of course I know that, we all know that, it's just constant (tears coming down the resident face, grinding their teeth together, with a clenched fist in frustration), they are always questioning me, hounding me and shaming me for smoking every day. During a concurrent observation and interview on 06/23/2023 at 6:50 AM, outside the facility grounds where Resident 33 pointed out the bush where they stashed their cigarettes and lighter was previously located. Staff F stated that the bush was 10 ft wide by four ft deep and six ft high and was taken out on 06/21/2023. Staff F further stated that the bush was taken out due to it being overgrowing onto the public sidewalk and that another reason was that sometimes homeless would stash things in the bushes. An orange lighter and broken cigarettes were observed in the dirt spot where the bush had been. Additionally, Staff F stated that some staff in the facility smoke but have to go out to the sidewalk to smoke and that they had seen Resident 33 smoking out by the bush. During an interview on 06/23/2023 at 7:17 AM, Staff O, LPN, stated that when they smoked during their shift, they must go off of the facility's property to the sidewalk. Staff O stated that residents were not allowed to have smoking paraphernalia at all in the facility and that it was a non-smoking facility. During an interview on 06/23/2023 at 7:38 AM, Staff P, Medical Records, stated that they smoked during their shift but were not allowed to smoke on the facility's property and must go outside to the sidewalk, which was public property. Staff P further stated that facility residents were not allowed to smoke while they were a current resident at the facility. During an interview on 06/23/2023 at 8:40 AM, Staff R, Admissions, stated that all the admission documents like the smoking policy communication were reviewed and signed by residents after they arrived at the facility. Staff R stated that the smoking policy communication form was not given to Resident 33 before they entered the facility. Additionally, Staff R stated that all the admission forms (including the smoking policy communication form) were reviewed and electronically signed by the resident on 05/26/2023 (the day after Resident 33 was admitted ). Observations on 06/23/2023 at 9:17 AM showed Resident 33 outside on the sidewalk smoking with their Resident Representative (RR). Staff E, LPN Admissions Nurse, was observed to walk up to the resident and RR. • Staff E stated, you know this is a non smoking facility. • Resident 33 stated that they were not on the facility's property and were allowed to smoke on the sidewalk because it was public property. • Staff E stated, Well I am a nurse and residents are not supposed to have cigarettes on them. • Resident 33 stated, I don't have any, my (RR) does. • Staff E stated (leaned forward and yelled in an accusatory manner), You're smoking one right now! • Resident 33's RR then stated, We are not on the facility's property and on public property, what is wrong with you people, why do you keep doing this? • Staff E stated Okay, fine! and proceeded to get into their car and drove off. During a concurrent observation and interview on 06/23/2023 at 9:24 AM, Resident 33 stared at Staff E (during their conversation and after the staff had left) crying. Why, why does this keep happening? This is ridiculous. Resident 33 and their RR stated that staff were continuously shaming and harassing the resident when they chose to smoke, even when they were following the rules and smoking off the facility's property. The resident stated that they were never informed prior to arrival at the facility that it was non-smoking and on 05/25/2023 they wanted to leave but they needed help with their medical care, so they signed the admission packet with the smoking policy communication form. If I wanted to be admitted I had to sign, or I was going to be pushed to the curb. Additionally, Resident 33 and their RR stated that they had seen multiple facility staff (from Resident 33's window, that faces the parking lot to sidewalk side of the facility) smoking on the sidewalk (the resident's mouth was wide open with a shocked look on their face, as they pointed at where they had seen staff smoking on the sidewalk). During an interview on 06/23/2023 at 10:32 AM, Staff F, stated that they remembered having a conversation with Resident 33 about smoking. Staff F stated that they went to the resident room after they had come back in from outside smoking and made sure that the resident did not have any smoking paraphernalia on them. Staff F stated that Resident 33 was off the premises (not on facility property) when they were smoking and did not have any smoking paraphernalia on them. Staff F stated that the resident had informed them that they were leaving their cigarettes and lighter in a bush outside and that after they had that conversation the bush was removed on 06/21/2023. I could see how (Resident 33) would think the bush got removed because (they) had stashed their cigarettes there. During a concurrent observation and interview on 06/23/2023 at 12:16 PM, Staff C and Staff D, stated they both discussed with Resident 33 concerns about their smoking while a resident in the facility, and that even on the resident's first day at the facility. Resident 33 was observed smoking outside. Staff C stated that the resident was anxious over a lot of stressors (death of their daughter, spouse and the loss of their home) in their life, they had a diagnosis of anxiety and smoked cigarettes as a coping strategy. Staff C stated that on the resident's first day at the facility (05/25/2023), they were informed about the non-smoking policy in the facility and Resident 33 wanted to leave (to not be admitted to the nursing home) because they were not going to be able to smoke. The resident decided to stay, and their cigarettes and lighter were confiscated and the resident was informed that they would get the cigarettes and lighter back when they discharged . Both Staff C and D stated that they constantly reminded Resident 33 every time they saw the resident coming in from smoking that the facility had a non-smoking policy and that residents could not have smoking paraphernalia on their person. Staff C stated yes Resident 33 did have the right to smoke and also to have their cigarettes if outside off of the facility's property, but that their process/policy was that residents were not allowed to have smoking paraphernalia on them or in their room. During an interview on 06/26/2023 at 11:22 AM, Staff E, stated that Resident 33 was not aware of the facility's non-smoking policy prior to their admission. Staff E stated that when Resident 33 was admitted , they denied wanting the nicotine patch so then review of the non-smoking policy was performed with the resident, which they were very upset about, and Resident 33 wanted to leave because they wanted to be able to smoke. Staff E stated that the normal process, for a resident that refused the nicotine patch and still wanted to smoke, would be to reapproach the resident about the nicotine patch and to inform the resident's medical provider, neither of which Staff E performed. Staff E stated that they had discussed the non-smoking policy on admission with the resident and on 06/23/2023 at 9:17 AM when they proceeded to yell at Resident 33 about smoking a cigarette on the sidewalk (outside of facility property). Staff E stated, Yes, I got a little upset (with Resident 33), I shouldn't have yelled at (Resident 33) or got upset. Staff stated that Resident 33 appeared distressed and upset about Staff E's conversation and that it was not the correct process, and that they should have remained calm. During an interview on 06/26/2023 at 1:31 PM, Staff M, Advanced Registered Nurse Practitioner, stated that they were not aware that Resident 33 had refused the nicotine patch, and that they were still smoking cigarettes. Staff M stated that if the resident had refused the nicotine patch and wanted to continue to smoke then they would have that right and Resident 33 was anxious so smoking would have been a coping strategy for their stress. During an interview on 06/27/2023 at 10:10 AM, Staff B, DNS, stated that they did not allow Resident 33 to check out their smoking paraphernalia when they go out to smoke and that the resident was allowed to smoke outside on the sidewalk. When progress notes from Social Services read and reviewed by Staff B, yeah, that would be very upsetting, and that they were not aware that Staff C and Staff D were constantly reminding the resident of the non-smoking policy after they would come in from smoking. Staff B stated that Resident 33 should have the right to their smoking paraphernalia, but that was against the facility's non-smoking policy. Staff B stated the process for smoking was not working for Resident 33 and that they have the right to smoke, and that Resident 33 should have access to their cigarettes and lighter. Review of Resident 33's medication administration record (MAR) for May and June 2023 showed that supplemental oxygen was ordered at two liters per minute (a unit of measurement for oxygen) on 05/29/2023, as needed, but had not been administered to the resident in May or June of 2023. During an interview on 06/27/2023 at 11:10 AM, Staff A, Administrator, stated that the policy did not specifically state to confiscate residents' smoking materials. Staff A stated that in Resident 33's case, they had received direction from their regional office to confiscate Resident 33's smoking paraphernalia and hold onto them until the resident discharged due to the resident having an as needed oxygen concentrator (supplies oxygen to the resident) in their room. Staff A stated that Resident 33 did not smoke in their room and did not bring the oxygen concentrator outside to smoke (as the resident had never used the oxygen while in the facility) but staff were not allowed to let Resident 33 have their cigarettes and lighter when they went out to smoke. Staff A stated that Resident 33 should not be continuously talked with about smoking every time the resident was noted to be smoking off of the facility's property. Staff A stated that Staff E's yelling at the resident and RR when smoking on public property was not the correct process and that the resident had the right to smoke on public property. Reference: WAC 388-97-0180(1-4)