Failure to Provide Nail Care for Residents Unable to Perform ADLs
Penalty
Summary
The facility failed to provide adequate nail care for three residents who were unable to perform activities of daily living (ADLs) independently, as observed and documented over several days. All three residents were severely cognitively impaired, with conditions such as dysphagia, aphasia, dementia, and senile degeneration of the brain, and had documented ADL self-care deficits in their care plans. Despite these documented needs, repeated observations revealed that each resident consistently had long, dirty, and unkempt fingernails. One resident also had chipped nail polish that was not addressed. Interviews with residents and their representatives indicated that nail care was often neglected unless specifically requested by family members. Staff interviews revealed confusion and inconsistency regarding responsibility for nail care. Certified Nursing Assistants (CNAs) reported being unsure whether they were permitted to cut fingernails, with some believing only a podiatrist could do so, while others stated they were only allowed to clean nails. The Unit Manager and an LPN clarified that CNAs were trained and expected to cut fingernails, with the exception of toenails, but acknowledged the confusion among staff. The facility's policy required appropriate ADL care, including nail care, for residents unable to perform these tasks independently, but this was not consistently implemented for the sampled residents.