Failure to Provide Nail Care for Resident Requiring ADL Assistance
Penalty
Summary
A deficiency was identified when a resident with vascular dementia, stage three kidney disease, anxiety, and a cognitive communication deficit did not receive appropriate nail care. The resident was cognitively intact and required staff assistance for activities of daily living (ADLs), as documented in the Minimum Data Set (MDS) and care plan. However, the care plan only specified assistance with bathing and did not address nail care. Medical records, progress notes, and skin and shower sheets over a two-month period contained no documentation of toenail care being provided, offered, or refused, nor any record of podiatry services. During observations and interviews, the resident was found to have long, thick toenails, with the left big toenail torn and jagged, and smaller toenails wrapping around the tips of the toes. The resident expressed interest in podiatry services and agreed to see a podiatrist. Staff confirmed the need for podiatry intervention and acknowledged that the resident was on a list for podiatry services, but there was no evidence that consents had been obtained or that services had been scheduled or provided. The facility's policy required assistance with ADLs for residents unable to perform them, but this was not followed in the case of nail care for this resident.