Failure to Provide Required ADL Assistance and Nail Care
Penalty
Summary
A deficiency was identified when a resident with a history of hypertensive heart and chronic kidney disease, end stage renal disease, and monoplegia of the upper limb was not provided adequate assistance with activities of daily living (ADLs), specifically nail care and meal assistance. The resident's assessment indicated a need for partial to moderate assistance with eating due to self-care performance deficits. During observation, the resident was found eating independently in her room, with food scattered on her chest, lap, and soiling her clothes and personal items. The lunch tray was not properly positioned for accessibility, and no clothing protector was used to prevent soiling, contrary to facility policy. Additionally, the resident was observed to have long, dirty fingernails with visible black matter, indicating a lack of nail care. Staff interviews confirmed that CNAs are responsible for both nail care and proper meal setup, but these tasks were not completed as required. The facility's policies on feeding and nail care were not followed, as evidenced by the lack of a clothing protector during meals and the failure to maintain nail hygiene during ADL care.