In this edition of The State of IJs, we’re spotlighting two Immediate Jeopardy (IJ) citations issued to Nevada nursing homes. These citations represent the most serious level of noncompliance, where resident safety is at immediate risk. Understanding the patterns behind these citations can help providers proactively address vulnerabilities and improve care outcomes.
Top Areas of Noncompliance
We’re discussing two IJ citations from Nevada in this post, both of which are vulnerable areas for providers in any state.
- F812 Kitchen Sanitation
- F689 Accidents (seeing a trend?)
We’ve discussed both of these tags – and it feels like F689 IJ scenarios are a never-ending thing – but there’s so many different concerns which can be identified under these tags that they just can’t be ignored.
The issues identified at an IJ level for F812 are worth mentioning briefly now, and then we’ll move on to a serious systems issue related to smoking.
F812 S/S: K (Pattern) – Walk-In Fridge
In several of our State of IJs posts, logs have been an issue – and here’s another scenario where an IJ could have been avoided with better monitoring and documentation. Staff responsible for managing your kitchen need to know what to look for to prevent issues such as this.
During the kitchen tour, the surveyor observed heavy ice build up on the walk-in refrigerator’s evaporator fans. This is no surprise, as it’s one of the areas surveyors are instructed to look for when they’re in the kitchen. The facility was cited for failing to ensure food was stored in a sanitary manner after it was discovered that perishable items were not stored within a safe temperature range of 35-41 degrees F. Review of the temperature logs found that the refrigerator had not been holding food in a safe range for multiple days, since there was a pattern of logged temperatures over 41 degrees F.
Staff need to know their responsibility is not just for logging the temperatures but alerting the appropriate individual or department to alert them that there’s an issue. In this case, staff should have notified Maintenance, but no one put two and two together that there was an issue. This was easily preventable. The Food Services Director or Supervisor needs to make it their business to monitor the content of all temperature logs – not only in the main kitchen but remote kitchens and pantries.
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F689 S/S: K (Pattern) – Smoking and Safety
A facility was cited for failure to ensure that three residents had appropriate interventions implemented to identify potential risks and hazards associated with smoking. There were three different situations that were all identified as potential accident hazards, so let’s see what happened:
- Observation of a resident’s room identified that there was a smell of cigarette smoke, and the resident was lying in his bed with a cigarette butt, ash and tobacco leaves on the floor next to a trash bin which contained combustible items and was located a few feet from the resident’s bed. The resident stated that he attempted to throw the cigarette butt into the trash but had missed. Even better – the resident stated that residents had been allowed to smoke on facility grounds until the survey team had arrived. The resident admitted to the surveyor that he had cigarettes and a lighter. One surveyor stayed behind to ensure the resident did not try to light another cigarette and put it in the trash. The resident refused to give the lighter and cigarettes to licensed staff once she had been notified by the surveyor.
- The same staff told the surveyors that she saw the first resident and another resident going outside together. The resident was interviewed in his room by the surveyor, and he stated that he used to go outside with other residents to smoke. An oxygen concentrator was observed by the resident’s bed. He refused to admit he had smoking materials. Review of the resident’s medical record found there was no smoking care plan.
- A third resident, who was identified by the second resident as also being a smoker, was interviewed in his room. He smelled of cigarette smoke and told the surveyor that up until two days prior (when the survey team arrived), the facility had allowed smoking on the premises. Signage indicating that smoking was not permitted on the facility grounds was added when the surveyors started. The resident stated he had not been told at the time of admission that the facility was non-smoking. When asked if he had smoking materials, he pulled a lighter out of his pocket.
Surveyor observations of the facility’s courtyard found cigarette butts on the ground.
The Statement of Deficiencies indicated that the facility failed to enforce elements of its smoking policy, including ensuring the employee smoking area was properly designated and equipped with a metal can with a self-closing lid. No safety items, such as a fire extinguisher, were located in areas where residents and staff had been smoking.
On interview, the Director of Nursing and Administrator both stated that the facility was a non-smoking facility since there were residents on oxygen.
Compliance Insights – Safe Smoking
Here’s what providers need to consider to avoid citations in this area.
- Enforcement Consistency – We’ve worked with many nursing homes on creating safe smoking programs, and one area facilities often can’t get right is enforcement of requirements for the safe smoking program and resident non-compliance. If you’ve got smoking contracts with your residents, enforce them. Residents need to understand – and adhere to – the conditions you’ve set forth.
- Always Maintain a Safe Program – As you can see, suddenly enforcing a no smoking policy at the start of survey is not a good plan. -When residents have been able to do as they pleased, trying to be compliant with no smoking is not going to be successful. Enforce your rules and requirements routinely for better compliance.
- Consistently Assess and Document – There needs to be evidence that residents have been assessed for their ability to safely smoke, that non-compliance has been identified and interventions are in place to prevent accidents. A care plan must be in place for residents who smoke to reflect these interventions. In the example discussed in this post, a resident who was also using oxygen was actively smoking and the facility didn’t have a plan in place for him. That’s a recipe for a disaster.
Received an IJ Citation? We’re Your First Call
CMS Compliance Group helps nursing homes respond to Immediate Jeopardy citations quickly and effectively—with root cause analysis, documentation support, and recovery planning.
Contact us today at (631) 692-4422 or cmscompliancegroup.com.
