Failure to Provide Required Nail and Oral Care for Dependent Residents
Penalty
Summary
The facility failed to provide adequate nail and oral care for three residents who required assistance with activities of daily living (ADLs). One resident was repeatedly observed with a dark or black substance under her fingernails over several days, and both the resident and a CNA confirmed that nail care was not being performed as required. The resident's care plan indicated she needed staff assistance for showers and nail care, and her MDS assessment showed she required substantial assistance with personal hygiene. Facility policy required cleaning the nail bed to prevent infection, but this was not followed. Another resident was observed with extremely long and curled toenails on multiple toes, and his records indicated he was totally dependent on staff for footwear and required maximum assistance with showers and nail care. There was no documentation of consent or refusal for podiatry services, and staff interviews revealed that the need for podiatry care had not been communicated to social services or the family. A third resident, who was cognitively impaired and required maximal assistance with oral care, was observed with thick white buildup and a film on her teeth and lips, as well as a blue substance and dry skin around her mouth. The DON confirmed that staff were responsible for ensuring residents were clean from food debris after meals, but this care was not provided as required by facility policy.