Deficiency in Personal Hygiene Care for Residents
Penalty
Summary
The facility failed to ensure that residents who were unable to carry out activities of daily living received the necessary care and services to maintain good personal hygiene. Specifically, two residents who required dependent assistance with activities of daily living were observed with long and ungroomed fingernails during multiple observations. Resident #52, who was cognitively intact and dependent on staff for personal hygiene, was observed with long and ungroomed fingernails on several occasions. The resident reported that their fingernails were rarely cut and that they had to wait frequently for nail care. Similarly, Resident #57, who had moderately impaired cognition and required assistance for hygiene, was also observed with long and ungroomed fingernails during multiple observations. Interviews with facility staff revealed that Certified Nurse Aides were responsible for providing personal hygiene care, including nail care, for non-diabetic residents. The Registered Nurse Unit Manager and the Director of Nursing both stated that residents' nails should be kept short and well-groomed, and that nail care should be completed as needed during care routines. Despite these expectations, the observations indicated that the facility did not consistently provide the necessary nail care for the residents, leading to the deficiency.
Plan Of Correction
Plan of Correction: Approved April 4, 2025 P(NAME) F677: I. Immediate Corrective Actions: Resident # 52 1. The licensed nurse provided nail care for Resident # 52. 2. OT reassessed residents right hand contracture to determine if Resident # 52 would benefit from any devices for bilat hand contractures. 3. The resident verbalized satisfaction with nail care provided. 4. The ADL CCP and CNAAR for Resident # 52 was updated by the RN regarding bilat hand contractures and provision of nail care. Resident # 57 1. The assigned CNA provided nail care for Resident # 57. 2. The resident verbalized satisfaction with nail care provided. 3. The ADL CCP and CNAAR for Resident # 57 was updated by the RN regarding the provision of nail care. II. Identification of Others: 1. The DON, in conjunction with the RNS, conducted Facility rounds to ascertain if any other residents were not provided with nail care. There were no additional issues found. III. Systemic Changes: 1. The DON/Administrator reviewed the PP for the provision of nail care for residents and it was determined to be in compliance. This PP will be in serviced to all licensed nurses and CNAs by the Designee. The lesson plan will focus on: - Reviewing the regulatory requirement (F677) that a resident who is unable to carry out activities of daily living receives the necessary services to maintain good nutrition, grooming, and personal and oral hygiene; - The responsibility of Nursing staff to ensure nail care is provided to all residents as needed; - The specific responsibility of the licensed nurse to provide nail care to residents with hand contractures; - The responsibility of the CNA to communicate to the Unit Nurse and/or RNS when nail care cannot be provided to a resident. IV. Quality Assurance: 1. The DON developed an audit tool to ensure residents are provided with nail care as needed. This audit will be completed by the RNS for 4 residents weekly x 4 weeks followed by 4 residents monthly for 11 months. 2. Findings from the audit requiring immediate corrective action will be rectified immediately. 3. Results from the audit will be brought to the quarterly QA meeting. V. Person Responsible: Director of Nursing