Failure to Maintain Resident's Personal Hygiene
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, a resident with intact cognition and impairments in both upper and lower extremities was dependent on staff for self-care abilities, including personal hygiene. Despite this dependency, the resident was observed on three occasions with long and dirty fingernails, indicating a lack of proper hygiene care. The resident expressed a desire to manage their fingernails but was unable to do so due to their condition and reported that staff were too busy to assist. Interviews with facility staff revealed that personal hygiene care, including fingernail clipping, was the responsibility of certified nurse aides. However, there was no specific documentation task for fingernail clipping, leading to inconsistencies in care. A certified nurse aide admitted to not remembering the condition of the resident's nails during hygiene assistance, while an LPN stated they clipped the resident's nails when the aides were busy. This lack of consistent attention to the resident's personal hygiene needs resulted in the observed deficiency.
Plan Of Correction
Plan of Correction: Approved March 21, 2025 F 677 ADL Care Provided for Dependent Residents I. The Following Actions were accomplished for the residents identified in the Sample: - Resident #27 was assessed by Licensed Unit Manager on 2/25/2025 and the designated C.N.A provided nail care, including trimming, and documented accordingly. - The C.N.A assigned to Resident #27 and the Licensed Practical Nurse #18 received in-service education on the importance of providing nail care for all residents. II. The following corrective actions will be implemented to identify other residents who may be affected by the same practice: - All residents have been identified as potentially affected by the same practices. - All Unit Managers will conduct direct care observations of all residents in their assigned units to ensure that fingernails are properly trimmed, cleaned and filed. - Any identified residents will be provided with nail care and will be documented accordingly. III. The following systemic changes will be implemented to ensure the deficient practice will not recur: - The Policy and Procedure titled Clinical, Activities of Daily Living Protocol and Policy was reviewed by the Administrator and Director of Nursing. No further revisions were necessary. - Nursing staff will be provided with in-service education by the Licensed Staff Educator or ADON on providing nail care and documented accordingly. IV. The facility’s corrective action will be monitored to ensure the deficient practice does not recur utilizing the following Quality Assurance practice: - The Director of Nursing/designee will develop an audit tool entitled “Nail Care – Personal Hygiene.” The Audit tool will be utilized to monitor ten (10) residents per week for each unit and all new admissions to ensure that nail care is provided and documented accordingly. - The audits will be conducted weekly for 3 months. - A quantitative summary of findings and corrective actions will be reported monthly to the Quality Assurance Performance Committee by the Director of Nursing/Designee. Responsible: Director of Nursing is responsible for ensuring all above is completed.