SPOKANE, WA - Federal inspectors issued immediate jeopardy citations to Spokane Health & Rehabilitation after discovering multiple residents smoking unsupervised on facility grounds, including one incident where a resident with cognitive impairments sat next to a propane tank with a lit cigarette.
The April 2025 inspection revealed the facility's failure to properly assess smoking risks, secure smoking materials, and implement adequate safety protocols despite maintaining a strict no-smoking policy. The violations prompted emergency corrective measures and highlighted systemic breakdowns in resident safety monitoring.
Critical Safety Breakdown Discovered During Inspection
The most serious incident occurred on April 15, 2025, when federal surveyors observed Resident 73 self-propelling in a wheelchair through the facility's patio area while holding a lit cigarette. The resident, who has Parkinson's disease and diabetes with documented cognitive fluctuations, attempted to enter a conference room where inspectors were meeting while still holding the burning cigarette.
The situation escalated when the resident moved to the barbecue area and positioned themselves directly next to a propane tank while continuing to smoke. Inspectors noted the absence of fire safety equipment, including fire blankets or proper ashtrays, creating an environment with significant fire and explosion risks.
Evidence of unsafe smoking practices was visible throughout the patio area. Inspectors documented black streaks on a white plastic table consistent with cigarettes being extinguished directly on the surface, indicating a pattern of improper disposal of smoking materials.
When interviewed, the resident stated they "liked to smoke three times a day" and confirmed there was no ashtray available for safe cigarette disposal. The resident's admission revealed they kept cigarettes and a lighter in their jacket pocket and had been smoking on facility grounds since admission in February.
Fire Alarm Incident Linked to Indoor Smoking
The facility's smoking supervision failures reached a critical point in December 2024 when another resident triggered the fire alarm system. At approximately 2:18 AM on December 29, 2024, smoke detectors activated and the fire department was dispatched after staff detected smoke in Resident 461's bathroom.
Despite the clear fire hazard, the resident refused to surrender smoking materials and told staff "I'm going to smoke no matter what." This incident required emergency one-on-one monitoring and ultimately led to the resident's discharge from the facility.
The fire alarm activation demonstrates how inadequate smoking oversight can create life-threatening situations for all residents. In nursing home environments, where many residents have mobility limitations or require assistance during emergencies, fire incidents pose extraordinary risks to the entire population.
Assessment and Documentation Failures
The inspection revealed significant gaps in the facility's resident assessment processes. Despite hospital records clearly documenting smoking histories, facility staff failed to conduct proper smoking safety evaluations or implement appropriate interventions.
For Resident 73, hospital documentation from January 2025 showed the individual smoked cigarettes "on some days," yet the facility's initial assessment marked them as a non-tobacco user. When staff discovered the resident smoking in February, they completed a safety evaluation that concluded the resident was "not a safe smoker" and could not properly handle cigarettes or use ashtrays safely.
However, the promised nicotine patch treatment was never implemented, and care plans lacked specific instructions for supervising smoking activities or securing smoking materials. The evaluation, completed 16 days after the initial smoking incident, failed to establish clear safety protocols or supervision requirements.
Medical Risks of Unsupervised Smoking in Healthcare Settings
Unsupervised smoking in nursing homes creates multiple health and safety hazards beyond fire risks. Residents with neurological conditions like Parkinson's disease often experience tremors and coordination difficulties that impair their ability to safely handle cigarettes and lighters.
Cognitive impairments can affect judgment regarding when and where smoking is appropriate, while medications commonly used in nursing homes may cause drowsiness or confusion that increases accident risks. Many residents also use supplemental oxygen therapy, which creates explosive fire hazards when combined with smoking materials.
The combination of these factors requires specialized supervision and safety protocols. Best practices include designated smoking areas with appropriate ventilation, fire suppression equipment, and trained staff supervision for residents who cannot safely manage smoking independently.
Systemic Communication and Training Deficiencies
The inspection revealed concerning gaps in staff knowledge about facility smoking policies and resident smoking status. Multiple staff members interviewed demonstrated limited awareness of which residents smoked or how to access smoking-related information in care plans.
One nursing assistant stated they were "unsure if there are smokers" in the facility, while other staff provided conflicting information about smoking policies and supervision requirements. This lack of coordinated communication created an environment where smoking violations could occur without detection or appropriate intervention.
The facility's administrator initially told inspectors during the entrance conference that there were no residents who smoked, despite documented evidence of multiple smoking residents and ongoing smoking-related incidents. This disconnect between leadership awareness and operational reality contributed to inadequate safety oversight.
Regulatory Standards for Smoking in Long-Term Care
Federal regulations require nursing homes to maintain safe environments and implement appropriate supervision for residents who smoke. Facilities must assess each resident's ability to smoke safely, provide necessary assistance or supervision, and maintain secure storage of smoking materials when residents cannot manage them independently.
When residents are determined unsafe to smoke independently, facilities must either provide constant supervision during smoking activities or implement smoking cessation programs with appropriate medical support. Care plans must clearly document supervision requirements and safety interventions specific to each resident's capabilities and limitations.
Additional Issues Identified
Inspectors documented several other violations during the survey, including inadequate infection control practices, medication administration errors, and deficiencies in resident care planning. The facility also demonstrated poor communication regarding resident preferences and safety needs across different care teams.
Documentation reviews revealed inconsistencies between hospital records and facility assessments, suggesting systemic problems with information transfer during the admission process. These issues contributed to the overall pattern of inadequate resident safety monitoring that characterized the smoking violations.
Immediate Corrective Actions Required
Following the immediate jeopardy finding, the facility implemented emergency measures including one-on-one surveillance for the primary resident involved, removal of unsecured smoking materials, and closure of unsupervised patio access. Staff received additional training on smoking policies and safety protocols.
The facility conducted a comprehensive review of all residents to identify smokers and completed new safety evaluations with appropriate care plan updates. Fire safety equipment was added to designated smoking areas, and enhanced communication protocols were established to ensure staff awareness of resident smoking status and supervision requirements.
These immediate actions addressed the most critical safety concerns, but the incident highlights the importance of proactive resident assessment and consistent policy implementation in nursing home environments where vulnerable populations require specialized care and protection.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for Manor Care Health Services-spo from 2025-04-24 including all violations, facility responses, and corrective action plans.
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