Failure to Provide Adequate Assistance with Personal Hygiene and Nail Care
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living, specifically in the areas of personal hygiene, for several residents who were unable to perform these tasks independently. One female resident was observed with excessive facial hair and dark matter under her fingernail, and reported not receiving scheduled showers due to pain from arthritis, which she could not manage without help. Documentation of her showers was incomplete or missing, and there was no record of her refusing care or assistance with facial hair removal. Her medical history included rheumatoid arthritis, dysphagia, diabetes with neuropathy, hypertension, acute kidney failure, and spinal stenosis, all of which contributed to her need for assistance with personal hygiene. Three other residents were observed with long, jagged, or dirty fingernails, and in some cases, debris under the nails. Interviews with staff and review of records confirmed that these residents required assistance with personal hygiene due to severe or moderate cognitive impairment, paraplegia, or hemiplegia following a stroke. The facility's care plans and Kardexes indicated that staff were to observe and trim nails on shower days, but observations and interviews revealed that this was not consistently done. There was no documentation in the electronic medical records of refusals of care for these residents. The Director of Nursing confirmed that CNAs were expected to check and provide nail care on shower days and during regular care, but this was not consistently documented or performed. Additionally, when requested, the facility was unable to provide the relevant policies for activities of daily living, shower, and nail care by the time of survey exit.