Unqualified Staff Performed Nail Care for Diabetic Resident
Penalty
Summary
A deficiency occurred when a staff member who was not qualified to perform nail care for diabetic residents cut the fingernails of a resident with diabetes. The resident, under the age of 65, had multiple diagnoses including dementia, diabetes, quadriplegia, contractures of both hands, and an anoxic brain injury. The resident was severely cognitively impaired and used a wheelchair. During an observation, an activities assistant removed a splint from the resident's contracted hand and proceeded to cut the fingernails on both hands, then applied lotion and replaced the splint. Interviews with facility staff revealed that activities staff are not permitted to trim or cut the fingernails of diabetic residents, as this task is reserved for the podiatrist or, in some cases, nurses due to the increased risk of wounds and infections in diabetic individuals. The activities director was unaware that the activities assistant had performed this task, and the DON confirmed that only the podiatrist or nurses should cut the nails of diabetic residents, not CNAs or activities staff. The incident demonstrated a failure to ensure that care was provided by individuals with the appropriate skills and training as outlined in the resident's plan of care.