Inconsistent Nail Care for Dependent Resident
Penalty
Summary
The facility failed to provide consistent assistance with nail care for Resident #15, who was dependent on staff for personal hygiene due to severe cognitive impairment and other medical conditions. The facility's policy required routine nail care following baths or showers, but observations during the survey revealed that Resident #15 had brown debris on their fingers, nails, and cuticles on multiple occasions. Despite the resident's need for total assistance with personal hygiene, there was no documented evidence of nail care being refused or performed, as required by the facility's policy. Resident #15, diagnosed with vascular dementia, congestive heart failure, and traumatic brain injury, was observed with soiled hands and nails on several occasions, indicating a lack of proper hygiene care. The resident's care plan required total assistance with bathing and nail care, yet observations showed the resident with brown debris under their nails and on their hands, even while eating. Interviews with staff revealed a lack of communication and documentation regarding the resident's nail care, contributing to the deficiency in maintaining the resident's personal hygiene.
Plan Of Correction
Plan of Correction: Approved March 19, 2025 F677 Corrective Action- To assure all residents who were unable to carry out activities of daily living (ADLs) receive necessary services to maintain good nutrition, grooming and personal and oral hygiene. 1. On 3/17/2, Resident #15 had proper nail care performed. Resident #15’s Care plan was reviewed for level of assistance required for hygiene and remains appropriate. 2. All residents residing in the facility who require assistance for nail care have the potential to be affected by this practice. A list of all residents who are dependent on staff for nail care will be created. These listed residents will then be audited for appropriate nail care. 3. To ensure this practice does not reoccur, the facility policy on Nail Care will be reviewed and revised if necessary. Education will be provided to all nursing staff (RNs, LPNs, and CNAs). The Director of Nursing/Designee will oversee in-services for all nursing staff. 4. To prevent further deficiency in this practice, the Director of Nursing/Designee will perform 10 resident audits per month for 3 months, and then as needed based on the audit findings. Audits will verify that proper nail care has been completed. The DON will monitor this process and review results monthly at QAPI meetings. If continued improvement is required, the committee may make further recommendations. The Director of Nursing will assume overall responsibility for the correction of F677.