Failure to Provide Routine Nail Care for Dependent Resident
Penalty
Summary
A resident who was severely cognitively impaired and diagnosed with cerebral infarction, quadriplegia, essential hypertension, and seizure disorders was found to be dependent on staff for all activities of daily living, including personal hygiene. The resident's care plan specified the need for total assistance with personal hygiene, and facility policy required regular cleaning and trimming of fingernails to prevent infection. Despite these directives, multiple observations over several days revealed that the resident's fingernails were about half an inch long and had black debris underneath. Staff interviews confirmed that the resident's nails had not been trimmed or cleaned as required, and there was uncertainty among staff regarding responsibility for nail care, especially since the resident was diabetic and required a nurse to perform this task. A family member also reported observing the resident's long and dirty fingernails and left a voicemail for the charge nurse requesting nail care, but the issue persisted in subsequent observations. Nursing assistants and an LPN acknowledged the condition of the resident's nails and described the process for nail care, but the care was not provided in a timely manner. The DON stated that nails should be cut on bath days or weekly, and recognized the risk of infection and dignity issues associated with untrimmed nails, particularly for residents with contractures. The facility's failure to provide routine nail care as outlined in the care plan and policy resulted in the resident having long, dirty fingernails over multiple days.