Failure to Provide Adequate Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically personal hygiene related to fingernail care, for two residents who were unable to perform these tasks independently. One resident, with diagnoses including parkinsonism and heart failure, required supervision or touching assistance with personal hygiene. Despite care plan interventions specifying that nail length should be checked and nails trimmed and cleaned on bath days and as necessary, this resident was observed on multiple occasions with long fingernails and a yellow-brown substance underneath. The resident reported that her nails needed to be cleaned and that she had not received nail care during her recent bed bath. Another resident, dependent on staff for personal hygiene due to hemiplegia following a stroke, was observed over several days with dirty fingernails containing a black substance. Although this resident stated a preference to clean her own nails and sometimes refused staff assistance, she also indicated she would not mind if staff cleaned her nails. Staff interviews revealed inconsistent awareness and follow-through regarding nail care responsibilities, with some staff unsure of the last time nail care was refused or performed. The care plan for this resident did not indicate any resistance to nail care. Facility policy required daily cleaning and regular trimming of nails to prevent infection, and staff interviews confirmed that nail care was expected to be performed on shower or bath days, with nurses responsible for diabetic residents. However, observations and resident interviews demonstrated that these procedures were not consistently followed, resulting in two residents having unclean and untrimmed fingernails over multiple days.