Deficiency in Personal Hygiene Care for Resident
Penalty
Summary
The facility failed to ensure that a resident who was unable to carry out activities of daily living received the necessary services to maintain personal hygiene. Specifically, Resident #29, who had severely impaired cognition and required dependent assistance with showers, was observed on multiple occasions with long, stained fingernails. The facility's policy on nail care, revised in 2011, stated that routine nail care should be done following baths and showers whenever possible. However, there was no documented evidence regarding the trimming or cleaning of Resident #29's fingernails, despite the resident's care plan indicating a need for maximal assistance with upper body bathing. During the survey, Certified Nurse Aide #7 admitted to not paying attention to the resident's fingernails when providing care and did not notice the long fingernails during a previous care session. The Licensed Practical Nurse Unit Manager #4 stated that CNAs were responsible for cutting residents' fingernails unless the resident was diabetic and that the CNA should have informed the nurse if a resident's nails were long. Upon observation, the Unit Manager confirmed that Resident #29's fingernails were indeed long, indicating a lapse in the facility's adherence to its own policies and procedures for maintaining residents' personal hygiene.
Plan Of Correction
Plan of Correction: Approved April 4, 2025 Resident #29 was offered nail care and declined nail care. Residents care plan was updated to reflect to encourage nail care per residents’ preference and as tolerated by the resident. The resident was monitored for 5 consecutive days for any emotional distress with no issues noted. The resident’s care plan was reviewed and is in concert with the resident’s current needs and a medical record review completed with no abnormal findings. Certified nurse aid #7 was educated on the policy of providing nail care to the residents as part of daily ADL’s. The CNA has since been re-audited and successfully demonstrated her understanding. All residents on the CNA's assignment had the potential to be affected by the deficient practice. Full house audit by Nurse Managers/designee will be completed to assure all residents' nails are clean and trimmed and care planned appropriately. Any instances of dirty nails were immediately rectified. Nurses and CNA’s will be educated by the DON/designee on the process of providing nail care during daily ADL’s and ensuring residents' nails are clean and trimmed as outlined in the resident’s plan of care. Weekly audits to be completed by the nurse manager/designee to ensure compliance with proper nail care and that residents' nails are clean and trimmed per care plan. Audits will continue until 100% compliance is attained for 4 consecutive weeks. The DON/ADON will review the audits for compliance. Any negative findings will result in immediate education. The audit results will be reported at the Monthly QAPI meeting. The frequency of ongoing audits will be determined by the QAPI committee based on audit results. The person responsible for the corrective action is the Director of Nursing/designee. Date of Compliance is 4/18/25.