Failure to Provide Regular Nail Care and Scheduled Bathing
Penalty
Summary
The facility failed to provide adequate personal hygiene and grooming services to two out of three sampled residents. One resident, who had multiple sclerosis and muscle weakness and required assistance with activities of daily living, reported that staff did not trim her fingernails regularly despite repeated requests. Observations confirmed her fingernails were long, and she expressed discomfort and concern about accidental scratches. Staff interviews revealed there was no set schedule or reminder system for nail care, and documentation of nail care was lacking. Another resident was observed with long fingernails containing blackish material, which he identified as dirt. He stated that staff did not regularly offer to clean his hands or trim his nails, and he would have appreciated more frequent care. Staff and the Director of Staff Development acknowledged that long and dirty fingernails were unacceptable and could harbor bacteria, but were unaware of the facility's policy on nail care frequency and could not provide documentation of recent nail care for these residents. Additionally, the facility did not ensure that one resident received showers or bed baths as scheduled. Review of shower flow sheets showed that the resident received only a few showers and bed baths over a four-week period, with some refusals noted but without documentation of the reasons for refusal. The resident was observed to be unkempt and to have a urine odor, and he reported not receiving daily bed baths or regular showers. He also stated that staff had stopped asking if he needed assistance with bathing, and he did not complain because he assumed staff were too busy. Interviews with staff, including unlicensed staff, the DSD, and the DON, confirmed that residents were expected to receive showers several times a week and daily bed baths if showers were refused. Staff acknowledged that refusals and reasons should be documented, but this was not consistently done. Facility policies required daily cleaning and regular trimming of nails, as well as documentation of nail care and bathing, but these practices were not followed for the residents involved.