Failure to Maintain Clean and Trimmed Nails for Dependent Residents
Penalty
Summary
The facility failed to ensure that residents who were dependent on staff for activities of daily living (ADLs) had their fingernails and toenails kept clean and trimmed, as required by facility policy. Observations and interviews revealed that three residents, all with significant medical histories and varying levels of cognitive impairment, had long, dirty, or jagged fingernails and, in one case, long and curled toenails. These residents were documented as requiring staff assistance for personal hygiene and nail care, and their care plans specifically directed staff to check, trim, and clean nails on bath days and as necessary. Staff interviews confirmed that nail care was considered part of ADL provision, and that the residents in question were dependent on staff for this aspect of their care. Certified Nursing Assistants (CNAs) and Licensed Vocational Nurses (LVNs) acknowledged that the residents' nails needed attention, with some staff noting that toenail trimming should be referred to a nurse or podiatrist. Despite these acknowledgments, the residents' nails remained untrimmed and uncleaned at the time of surveyor observations. Residents themselves expressed a preference for having their nails kept clean and trimmed, and in one case, a resident reported that no one had ever offered to trim their nails. Facility leadership, including the Director of Nursing and the Administrator, stated that their expectation was for staff to keep residents' nails trimmed and clean, yet this standard was not met for the sampled residents reviewed during the survey.