Failure to Provide Adequate Nail Care
Penalty
Summary
The facility failed to provide adequate nail care to a resident who was unable to perform activities of daily living (ADLs) independently. This deficiency was identified during a survey when Resident #122 was observed with long, squared nails with sharp edges. The resident, who had a history of type II diabetes mellitus, anxiety disorder, muscle weakness, and lack of coordination, was cognitively intact but required supervision or assistance with personal hygiene. Despite the resident's inability to cut their own nails due to arm shakiness, the Certified Nursing Assistant (CNA) admitted to not providing nail care, even though it was part of his responsibilities. Interviews with facility staff, including a Licensed Practical Nurse (LPN) and the Director of Nursing (DON), revealed that nail care was recognized as important for infection control and hygiene. However, the LPN noted that the resident was confused and had refused nail care on a previous occasion, although the resident was generally calm and cooperative. The facility's policies on nail care and ADLs emphasized the importance of routine cleaning and inspection of nails, yet these were not adequately followed for Resident #122, leading to the observed deficiency.
Plan Of Correction
F677- ADL Care Provided for Dependent Residents What corrective action will be accomplished for those residents affected by the deficient practice? Resident #122 was provided with ex order 26.4 by the caretaker on 12/18/2024. How will the facility identify other residents having the potential to be affected by the same deficient practice and what corrective action will be taken? All residents have the potential to be affected by this alleged deficient practice. The Unit Managers checked all residents for nail care and if nail care was required, the resident care team provided nail care. What measures will be put into place or what systemic changes will be made to ensure the deficient practice will not recur? Policy for resident hygiene was reviewed. Clinical staff were educated on the importance of providing routine hygiene practices for residents. Unit managers or designee will monitor resident hygiene routine to ensure care is being provided. How will the corrective action be monitored to ensure the deficient practice will not recur? Director of Nursing or designee will audit residents' nails to ensure they have been provided with nail care. The audit will be conducted once a week for one month, then monthly x3. The results of the audit will be reviewed at the facility QAPI meeting x3 months.