Failure to Provide Timely Fingernail Care for Residents
Penalty
Summary
The facility failed to provide timely fingernail care for two residents, leading to deficiencies in their activities of daily living (ADLs) care. Resident #6, who has severe cognitive impairment and requires substantial assistance for personal hygiene, was observed with excessively long fingernails containing a red-brown substance. Despite the care plan instructions to check, trim, and clean nails on bath days and as necessary, the resident's nails were not adequately maintained. Observations revealed the resident using her long nails to scratch an open area on her face, resulting in bleeding. Interviews with staff indicated confusion about responsibility for nail care, with some staff believing it was the responsibility of the activities department rather than the CNAs. Resident #61, also with severe cognitive impairment and needing moderate assistance with personal hygiene, was observed with long fingernails containing debris. The resident expressed dissatisfaction with the nail length and stated it had been several weeks since they were last trimmed. Despite the care plan's instructions for regular nail maintenance, the resident's nails remained long and uncleaned until several days after the initial observation. This deficiency highlights a lack of adherence to the facility's nail care policy, resulting in inadequate personal hygiene care for the residents.
Plan Of Correction
F677 Tag ADL Care: Nail grooming not performed for two residents #6 and #61. What corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice? Resident #6, nails were cut and cleaned during survey. Resident #61, nails were cut and cleaned during survey. How will you identify other residents having potential to be affected by the same deficient practice and what corrective action will be taken? An audit of all residents' nails was conducted to identify other residents who may be affected by deficient practice. Any exceptions found were addressed at the time of the audit. What measures will be put into place or what systemic changes will you make to ensure that the deficient practice does not recur? Nursing staff educated re residents' nail grooming and cleanliness during daily ADL care by: Weekly audits x 4 weeks will be conducted, then bi-weekly x 2, then monthly x 1 to identify any deviation from the compliance plan by: Guardian angels will do weekly checks of assigned residents' nails during their routine rounding for need of grooming and report need to Unit Managers for care by: How the corrective action(s) will be monitored to ensure the deficient practice will not recur, i.e., what quality assurance program will be put into place? The plan will be submitted to the QAPI process for monitoring and review x 3 months or until substantial compliance. Preparation and/or execution of this plan does not constitute admission or agreement by the provider of the truth of the facts alleged or conclusions set forth on the statement of deficiencies. This plan of correction is prepared and/or executed solely because it is required by the provisions of federal and state law.