Failure to Provide Proper Nail Care for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident, who was substantially to totally dependent on staff for all activities of daily living (ADLs) except eating due to a stroke affecting her left side, did not receive proper nail care as required by her care plan. The care plan specified that staff should check, trim, and clean the resident's fingernails on bath days and as necessary. Despite this, documentation from certified nursing assistants (CNAs), progress notes, and additional care plans lacked any record of nail care being provided or refused for this resident. Observations revealed that the resident's right-hand fingernails were significantly overgrown, extending nearly a centimeter beyond the fingertip, and had visible debris underneath, while the left hand was clean and trimmed. The resident, who was cognitively intact, initially stated she cared for her own nails but later acknowledged receiving help. Interviews with staff indicated confusion about who was responsible for nail care, with some believing hospice or activities staff provided it, while the care plan clearly assigned this responsibility to CNAs on bath days. The condition of the resident's nails remained unchanged over several days of observation.