Failure to Trim and Clean Dependent Resident's Fingernails
Penalty
Summary
A deficiency was identified when a resident, admitted with adult failure to thrive and parkinsonism and assessed as severely cognitively impaired, was observed to have fingernails that were excessively long, measuring approximately three-fourths to one inch. The resident was dependent on staff for activities of daily living (ADL) care, including personal hygiene, and required substantial to maximum assistance. During observations, the resident's fingernails were noted to have black debris and food particles underneath, particularly after eating with her hands. The care plan indicated the need for staff assistance with ADLs due to the resident's cognitive and physical limitations. Interviews with staff revealed that nurse aides were responsible for trimming fingernails unless the resident had diabetes, in which case the nurse would perform the task. The assigned nurse aide acknowledged noticing the long fingernails and reported it to the nurse, but the nurse had not observed the issue. The Director of Nursing confirmed that fingernails should be checked and trimmed as needed during showers or bed baths, and that the resident's nails should have been trimmed and cleaned by staff. The failure to provide this care resulted in the resident having untrimmed and unclean fingernails despite being dependent on staff for hygiene.