EMERALD PARK HEALTH CARE CTR Facility I.D. Number 0040816 Date of Survey: 07/03/01 Complaint Investigation “A" VIOLATION(S): The facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental, and psychosocial well-being of the resident, in accordance with each resident’s comprehensive assessment and plan of care. Adequate and properly supervised nursing care and personal care shall be provided to each resident to meet the total nursing and personal care needs of the resident. Personal care shall be provided on a 24-hour, seven-day-a-week basis. All necessary precautions shall be taken to assure that the residents’ environment remains as free of accident hazards as possible. All nursing personnel shall evaluate residents to see that each resident receives adequate supervision and assistance to prevent accidents. This REQUIREMENT is not met as evidenced by: Based on observation, interviews and record and policy review the facility failed to provide adequate supervision of resident smoking to prevent a fire hazard. Findings include the following: June 25, 2001 at about 4:00p.m. surveyor heard someone yell, "FIRE". The fire alarms were then noted to be running and a code red was announced for first floor south. The first floor hallway south was noted to be filling with thick black smoke. The residents from first floor south were evacuated to the parking lot and the remaining residents were placed behind fire doors on the second and third floors. The majority of residents on the first floor are ambulatory. At 4:05p.m. the exterior portion of the south wing of the building was observed with flames and smoke. The flames were noted to be reaching the third floor. A wooden fence in front of the basement windows and vents that housed laundry area was also noted on fire. E#5 was observed using a fire extinguisher to attempt to extinguish the fire. Large billows of smoke as well as shooting flames were noted. The fire department responded around 4:10p.m. and proceeded to extinguish the fire. At 5:00p.m. the fire department issued clearance for residents and staff to reenter the South wing and an all clear was called except for rooms 139 and 236. At 5:10p.m. during the tour of the building, a strong odor of smoke and a mist of smoke was still noted in rooms on the first floor south. Room 139 was noted with water on the floor, window out, and smoke still present. The window air conditioner unit was noted to be burnt. Rooms 138, 137, and 136 were noted with a strong odor of smoke and fire. Room 236 was noted to be filled with smoke, a strong odor of smoke and the air conditioning unit was burnt. The facility laundry area located below room 139 in the basement of the facility was filled with smoke and water. All linens and items stored were wet or covered with debris. Z#1, Evergreen Park Fire Chief, stated to the administrator in the presence of the surveyor on June 25, 2001 at 5:35p.m., that the fire was caused by a cigarette butt tossed out of the window of Room 236 and igniting the bird nest under the air conditioner and falling to the ground and igniting the lint debris from laundry vents. Z1 also stated that the fire department had found numerous cigarette butts in Room 236 and the window ledge of Room 236. Z1 stated that a citation would be issued. A review of the Evergreen Park Fire Department violation notice reveals that the facility was cited on June 25, 2001 for "numerous open electrical boxes and exposed wiring at the rear of clothes dryers in laundry room" and "citation issued for failure to supervise/enforce no smoking in patient rooms." A review of the Evergreen Park Fire Department Investigation Report reveals the following, "The R/I's examined Room number 236, which was the second floor room above the area of the fire. The R/I's noted that part of the window air conditioner had burned. The R/I's noted several cigarette butts in the tract of the window framing. Also located was a burnt match on the floor under the window of this unit. On further investigation, the R/I's located a book of matches and a lighter in this room. .." The report continues to note that "Numerous cigarette butts were discovered on the ground in and around the dryer vent enclosure". The report concludes the following, "The cause of the fire appears to be accidental due to the careless use of smoking materials". "That numerous cigarette butts found on the ground outside in the areas of origin matched the same brand as cigarettes found in room 236 and in the window tracts of that room." "It appears that these cigarettes had been dropped out of the windows of the rooms above." "It was obvious due to cigarettes, cigarette butts, and matches found in these rooms that unsupervised smoking had been taking place." During the survey orientation tour of June 24, 2001 at 9:30 on the second floor, R#17 was noted to be smoking in the hallway near the South dining room. R#17 did not have an ashtray and was dropping ashes into his hands. Later during the tour R#17 was observed in room 236 smoking in bed. E9, floor nurse, stated that R17 has been caught smoking in his room before. A review of R17's record indicates that the resident had been caught smoking prior to the survey and counseled. R17 has also signed on May 14, 2001 a "Smoking Rules and Regulations". The smoking rules and regulations state, "You MAY NOT smoke in your rooms or bathrooms." A smoking care plan was placed in R#17's chart dated June 18, 2001. R#31 also resides in Room 236. A review of R#31's medical record indicates that R#31 also has documented incidences of smoking in his room or other inappropriate areas. R#31 also has a care plan dated June 18, 2001 for smoking. R#31's care plan states: "chronic smoker, prone to smoke in unauthorized areas - room". R#31's care plan list as interventions: "Encourage to smoke in authorized areas, reassess knowledge about smoking policy and safety hazards, check bedside daily for cigarettes...". Nursing notes for R#31 for June 24, 2001 state, "Resident found in room smoking counseled on fire hazards and safety will make Social Service aware all cigarettes taken". Interview with E9, facility administrator, on June 24, 2001 during the daily status meeting confirms that smoking is not allowed in resident rooms and only in designated areas. A review of facility policy confirms that smoking is allowed only in designated areas. Minutes from a special resident council meeting of January 19, 2001 reveal that residents were advised of the smoking policy and that room checks would be conducted. The facility failed to provide adequate supervision and enforcement of R17's and R31's plan of care to prevent a fire and or hazard. |