Failure to Provide Adequate Nail Care and Hygiene
Penalty
Summary
The facility failed to ensure that a resident who was unable to carry out activities of daily living received adequate grooming and personal hygiene services. Specifically, the resident was observed on multiple occasions with dark brown debris under their fingernails while eating with their hands. The facility's policy required that residents receive sponge baths twice daily, including nail care, but this was not adhered to for the resident in question. The resident, who was severely cognitively impaired, had a care plan that specified they required moderate assistance for personal hygiene and eating. Despite this, the resident's treatment records for nail care were incomplete, and there was no documentation of any refusals of care. Observations over several days confirmed that the resident's nails were not cleaned, and staff failed to provide or offer nail care during routine care activities. Interviews with staff, including CNAs, LPNs, and the Director of Nursing, revealed that nail care was expected to be provided whenever needed for infection control and general hygiene. However, the staff did not follow through with these expectations, and there was a lack of documentation regarding any refusals of care. The facility's failure to provide necessary nail care was acknowledged by multiple staff members, including the Administrator, who emphasized the importance of maintaining resident hygiene for dignity and infection control.
Plan Of Correction
Plan of Correction: Approved May 1, 2025 Corrective Action for Resident Identified: Upon identification, staff immediately assisted the resident with hand hygiene and nail care. The resident’s care plan was reviewed and updated to ensure nail care is provided and documented as part of daily grooming tasks. The CNA assigned to the resident received immediate re-education regarding proper hygiene assistance and documentation practices. The facility will conduct an audit of all residents requiring assistance with ADLs, focusing specifically on grooming and nail care. Additionally, the Occupational Therapy department will identify residents who eat with their hands and their need for appropriate assistive devices. Dietitians will also be consulted to assess whether alternative food options are more suitable for the identified residents. The audit will include visual inspections, interviews, and documentation review. Systemic Changes to Prevent Recurrence: The facility’s Resident Hygiene Policy was reviewed and clearly defines staff responsibilities regarding nail care and hygiene for residents requiring ADL assistance. All direct care staff will receive in-service education covering: - Importance of maintaining personal hygiene for residents - Proper nail care techniques - Infection control concerns related to unclean hands and fingernails - Preserving resident dignity during meal times and hand hygiene before and after meals. Monitoring and Quality Assurance: The Director of Nursing (DON) or designee will perform random weekly audits of 5 residents requiring ADL assistance for 8 weeks to ensure nail care and hygiene are being performed and documented. Resident mealtimes will be observed daily by nurses to ensure residents are assisted with hand hygiene prior to eating. Results will be reviewed monthly by the Quality Assurance meetings, and corrective action will be taken immediately for any noncompliance. If compliance is maintained at 100% for 8 weeks, audits will transition to monthly for 3 additional months. Responsible Person: Director of Nursing or Designee