Failure to Provide Nail Care Assistance for Dependent Residents
Penalty
Summary
The facility failed to provide adequate assistance with nail care for two residents who were unable to perform this activity of daily living independently. One resident, with diagnoses including metabolic encephalopathy, type 2 diabetes mellitus, dermatophytosis, and varicose veins with ulcer, was dependent on staff for bathing, personal hygiene, and required assistance with dressing and footwear. Observations revealed that this resident had thick, long, and curling toenails. The resident expressed a desire to have her toenails trimmed, but staff indicated that due to her diabetes diagnosis, only the podiatrist could perform this care, and she was not currently on the podiatrist's list. The podiatrist only visited every two months, and the resident was at risk for ingrown toenails and skin injury if her nails were not trimmed. Another resident, with a history of stroke, muscle wasting, diabetes, and major depressive disorder, required substantial to maximal assistance with personal hygiene and was dependent on staff for several ADLs. During observation, this resident was found to have long fingernails with a grayish substance underneath. The resident stated discomfort and a desire for nail care. A CNA confirmed the condition of the nails and stated that they should be trimmed and cleaned to prevent infection. The resident had not been referred for podiatry care, and staff interviews revealed that nail care was considered an implied daily task for nurses, with referrals to the podiatrist as needed for complex cases. Review of facility policy indicated that appropriate care and services should be provided for residents unable to carry out ADLs independently, including hygiene and grooming. Despite this, both residents did not receive necessary nail care, as observed and confirmed by staff and record review. The lack of timely nail care for these dependent residents constituted a failure to meet their basic hygiene needs as outlined in their care plans and facility policy.