Failure to Provide Adequate Assistance with Grooming and Nail Care
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically in maintaining good grooming and personal hygiene for two residents who were unable to perform these tasks independently. One resident, a female with a history of heart disease, type 2 diabetes, and hypertension, required substantial to maximal assistance with personal hygiene. Observations on two consecutive days revealed that her fingernails were approximately 0.5 inch in length with a dark brown substance underneath, indicating they had not been cleaned or trimmed. The resident reported she could not recall the last time her fingernails were trimmed and stated that no one had asked her about nail care. Staff interviews revealed confusion regarding responsibility for nail care, with CNAs believing nurses or the podiatrist were responsible, and nurses indicating that podiatrist visits were infrequent and that CNAs should clean the nails as needed. Another resident, a woman with diagnoses including enterocolitis due to clostridium difficile, morbid obesity, and muscle weakness, was observed to have facial hair about an inch long on her chin and fingernails that were 0.5-0.7 cm in length with a dark substance underneath. This resident was dependent on staff for showering, bathing, and toileting hygiene, and expressed a desire to have her facial hair removed and fingernails cut, stating that no one had asked her about these grooming needs. Staff interviews confirmed that the resident's grooming needs had not been noticed or addressed, and acknowledged that long and dirty nails could pose a risk of infection and negatively affect the resident's self-esteem. Review of the facility's policy on activities of daily living indicated that residents should receive assistance as needed to complete ADLs, including ensuring fingernails are clean and trimmed to avoid injury and infection. Despite this policy, the facility did not ensure that dependent residents received adequate assistance with nail care and grooming, as evidenced by the observations and staff interviews.