Failure to Provide Routine Nail Care and Showers for Dependent Residents
Penalty
Summary
Surveyors found that the facility failed to provide necessary assistance with activities of daily living (ADLs), specifically routine nail care and showers, for two residents who were dependent on staff for these services. One resident, with chronic obstructive pulmonary disease, hypertension, and diabetes, was documented as dependent for bathing and required assistance with personal hygiene. Despite records indicating that showers and nail care were provided on specific dates, observations revealed the resident had long, dirty, and untrimmed fingernails on multiple occasions. The resident reported that staff did not cut or clean her fingernails, and a CNA confirmed the nails were untrimmed and unclean, stating that nail care should be completed with each shower. Another resident, diagnosed with Parkinson's disease, psychotic disorder, diabetes, and other conditions, was also dependent for bathing and had a documented preference for three to four showers per week. Interviews with the resident's wife indicated that the resident was not consistently receiving showers or oral care as preferred, sometimes receiving fewer than two showers per week. Review of records showed missed showers on several scheduled days, and on one occasion, a bed bath was provided instead of a shower without explanation. Staff interviews confirmed that the resident did not receive showers as scheduled and that decisions about showering were sometimes left to the resident's wife.
Plan Of Correction
The facility will continue to offer showers and nail care to dependent residents. Resident #9 and #70 continue to reside at the facility. On 3/25/2025, direct care staff offered nail care to resident #9 and resident #70, and both residents accepted. CNA #80 was reeducated on offering nail care if nails appear soiled or jagged in between shower frequency. Resident #2's care plan for ADLs was reviewed by the IDT. Resident #70 was offered a shower on 3/26/2025 and accepted. STNA #80 was reeducated by the Nurse Manager on 3/25/2025 to ensure offering showers per the resident's preference and proper documentation of showers and refusals of showers. An initial audit of residents' shower preferences was conducted on 4/10/2025 by the DON. Shower schedules were reviewed and updated as needed. An initial observation audit of residents' fingernails was conducted on 4/9/2025 by the DON. Negative findings were corrected by offering/performing nail care. By 4/17/2025, facility direct care staff and licensed nurses will be reeducated by the DON and nurse management team. Reeducation will consist of expectations of staff offering/providing daily grooming and hygiene care, such as but not limited to; showers per preference, hair care, oral care, dressing, shaving, and nail care. Weekly, for 2 weeks, or as directed by the QA committee, the DON and/or designee will audit 5 random residents, ensuring showers and nail care are provided. Negative findings will be corrected by offering the resident a shower and/or nail care and reeducating the staff. Negative findings will be reported to the QA committee for review. The Administrator will ensure the completion of the audits. The DON is responsible for the ongoing compliance.