Failure to Provide Required Nail Care for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident with rheumatoid arthritis, generalized muscle weakness, and impaired mobility, who was dependent on staff for all activities of daily living (ADLs), did not receive necessary assistance with personal hygiene. The resident's medical record included a physician's order to have fingernails trimmed every two weeks, and the care plan specified extensive assistance with all ADLs, including personal hygiene. However, review of the Treatment Administration Record (TAR) for March and April did not show documentation that fingernail trimming was performed as ordered. During observation, the resident was found to have long, jagged, and dirty fingernails, and reported having requested nail trimming without receiving it. Interviews with nursing staff confirmed that the resident's fingernails should have been trimmed by the floor nurse every two weeks, and that there was no documentation of this care being provided. The failure to provide this basic hygiene service constituted a lack of necessary care for a resident unable to perform ADLs independently.