Bridgeview Center

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some

FORM CMS-2567 (02/99) Previous Versions Obsolete

smoke today. She mentioned that she had been in the facility for almost a year and residents were not supervised during smoking until today. She confirmed that Residents #7 and #8 were smoking cigarettes.

She stated that she was not asked to take the smoking paraphernalia.A review of the facility's smoking policy tilted Smoking/vaping contract acknowledgement: updated on 1/27/2025 revealed the following:PURPOSE: To provide residents with the privilege of smoking/vaping and/or use of electronic smoking devices while maintaining their safety and the safety of others. Facility Policies:Resident smoking, vaping and/or use of electronic smoking devices is permitted only in the designated smoking area. All other areas of facility property are smoke free.2. All residents who smoke/vape and/or use electronic smoking devices will be assessed upon admission or at the start at such activity and as their cognitive and/or physical status mandates.3. Residents who require supervision will only use tobacco products and/or nicotine with supervision at the appointed smoking times (this includes electronic cigarettes). Residents who use tobacco products and/or nicotine with an electronic smoking/vaping device will have a care plan. 4.

If determined the resident is unsafe when smoking and/or vaping, they will have supervision during such activity.5. Residents are to only smoke/vape the products that are purchased specifically for them. There is no borrowing or sharing of tobacco/nicotine products between Residents or Staff. If a Resident does not have tobacco products/nicotine they cannot smoke/vape.6. Tobacco products will be dispensed one at a time per resident request, with a limit of two cigarettes per supervised smoking break. Electronic smoking/vaping devices will be dispensed with prefilled cartridge.7. Absolutely no tobacco paraphernalia and/or tobacco products are to be kept in resident rooms. Electronic cigarettes, vaping devices including prefilled cartridges, nicotine, batteries, and/or charging elements for such devices are not permitted in a resident's room.8. If at any time, a resident is found with tobacco, nicotine and/or smoking/vaping materials (including lighters, matches, electronic cigarettes, prefilled cartridges, etc.) in his/her room or is found smoking, vaping, and or using an electronic smoking device (i.e. e-cig) in the room or inside the facility, such articles will be removed, smoking/vaping privileges will be revoked, and could result in Resident discharge from the facility. 9. If at any time this policy/contract is violated, smoking/vaping and/or tobacco/nicotine usage privileges will be revoked.10.Tobacco/Nicotine and smoking/vaping privileges may be revoked or limited at any time at the discretion of the facility administration.11. No resident may smoke/vape and/or use an electronic smoking device while on oxygen. 12. Smoking/Vaping paraphernalia for all residents will be secured by staff and labeled with individual resident names. 13.

E-Cigarettes/Electronic Smoking Devices/Vaping Devices are considered the same as cigarettes and are subject to the same policies. 14. Any resident witnessed using/obtaining/storing illegal smoking/vaping materials and/or paraphernalia on facility property is subject to a 30-day discharge notice. Local Law Enforcement will be notified. PROCEDURE: A licensed nurse will evaluate residents who smoke, vape, or use electronic smoking devices upon admission or at the start of such activity and as cognitive or physical status changes warrant 2. Residents who smoke, vape, use electronic smoking devices are only permitted to do such activity in the designated smoking area. Residents will periodically be reviewed to reassess their ability to smoke/vape or use tobacco/nicotine safely.Residents will be offered and encouraged to use smoking aprons. I, ---------------------have reviewed and agree to the above smoking/vaping policy and procedure contract and further agree to abide by these guidelines in order to continue smoking/vaping privileges. I further acknowledge that my room or personal belongings may be searched for by facility staff at any time if I am suspected of violating any aspect of this smoking agreement.

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