Failure to Provide Required Nail Care for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident who was dependent on staff for activities of daily living (ADLs) was not provided with necessary nail care. The resident, who had diagnoses including metabolic encephalopathy, diabetes, gait abnormalities, and depression, required substantial to maximal assistance with personal hygiene, including nail care, as documented in her care plan. Despite this, observations revealed that the resident had long fingernails and toenails, with some toenails curved and causing discomfort by poking her other toes. The resident reported that she had requested nail trimming from staff over a month prior, but the care had not been provided. Certified Nurse Assistant (CNA) staff confirmed awareness of the resident's long nails, noting that they had observed the issue during showers and reported it to nursing staff approximately two weeks earlier. Facility documentation, including multiple "Skin Monitoring: Comprehensive CNA Shower Review" sheets, consistently indicated that the resident needed her toenails cut, with both CNA and nurse signatures, but no interventions were documented in response. The facility's process required nurses to perform nail care for diabetic residents and to refer residents needing special tools to a podiatrist, but the resident was not included on the podiatry referral list, and no action was taken to address her nail care needs. Interviews with facility leadership, including the Social Services Director, Director of Staff Development, and Director of Nursing, confirmed that nail care should be assessed and performed regularly, particularly for residents with diabetes, and that failure to provide this care could result in skin injury or infection. The facility's policy required provision of necessary services for residents unable to perform ADLs, including grooming and personal hygiene, but this was not followed in the resident's case.
Plan Of Correction
F677 ADL Care Provided for Dependent Residents How the corrective action(s) will be accomplished for those residents found to have been affected by the deficient practice: a) Resident #70 had their fingernails trimmed and toes trimmed on 04/10/2025. How the facility will identify other residents having the potential to be affected by the same deficient practice and what action will be taken: b) Audit of all residents was completed on 04/09/2025 by MDS LVN/designee to ensure that residents had cleaned, well-trimmed fingernails and toenails. All residents have the potential to be affected by this deficient practice. No other residents were affected by the deficient practice. What measures will be put into place or what systemic changes you will take to ensure that the deficient practice will not recur: c) In-Service was conducted by DON / DSD to LN and CNA staff from 04/10/2025 through 04/17/2025 regarding the importance of ensuring that all residents have cleaned, well-trimmed fingernails and toenails. d) LN supervisor / designee review shower sheets and check resident nails the following day to ensure that nails and toenails are being kept cleaned, and well-trimmed. Any issues identified during these audits will be brought forth to the five-day a week department manager morning meeting for review, validation and immediate correction. How the facility plans to monitor its performance to make sure that solutions are sustained: e) LN Supervisor / designee review shower sheets and check resident nails the following day to ensure that nails and toenails are being kept cleaned, and well-trimmed. Any issues identified during these audits will be brought forth to the five-day a week department manager morning meeting for review, validation and immediate correction. Non-compliance issues identified will be reviewed and resolved. Administrator and/or designee will do trending/analysis and will report to the quarterly QAPI Committee for further evaluation and/or recommendations. 04/17/2025