Failure to Provide Required ADL Care: Nail Hygiene and Repositioning
Penalty
Summary
Four residents did not receive appropriate assistance with activities of daily living (ADLs), specifically in the areas of personal hygiene and mobility. Two residents with cognitive impairment and one with visual impairment were observed to have long fingernails with black matter underneath, and one had overgrown fingernails. These residents required at least partial assistance with personal hygiene, as documented in their assessments. Staff interviews confirmed that nail care was not provided as required, and in one case, a CNA incorrectly stated that a resident refused care, which the resident denied. Nursing staff acknowledged the importance of nail care, especially for residents with conditions such as diabetes and a history of scratching wounds, but confirmed that care was not provided. Another resident, who was dependent on staff for all ADLs due to severe cognitive impairment and physical limitations, was not turned and repositioned every two hours as indicated in the care plan. Observations showed the resident remained in the same position for several hours. Staff interviews revealed that the repositioning task was not included in the daily task list or electronic health record for this resident, resulting in the omission of this essential care activity. Both CNAs and RNs acknowledged the importance of regular repositioning for this resident. Facility policy and procedure documents reviewed by surveyors indicated that daily cleaning and regular trimming of fingernails, as well as scheduled repositioning for dependent residents, are required to prevent infection and skin breakdown. The Director of Nursing confirmed that the lack of nail care and repositioning placed residents at risk for infection and skin injury, and that the required care was not provided according to facility policy.