Failure to Provide Regular Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide necessary grooming and personal care services for two residents who required assistance with activities of daily living (ADLs). Both residents had significant physical limitations due to conditions such as hemiplegia and hemiparesis following strokes, which left them unable to perform their own nail care. Despite care plans indicating the need for staff assistance with all ADLs, including regular nail care, both residents were observed with long fingernails containing a visible black/brown substance underneath, and one resident also had long toenails. Both residents reported being unable to trim their own nails and stated that staff had not been checking or providing nail care as needed. Interviews with staff, including the administrator, DON, ADON, LVNs, and CNAs, revealed inconsistent understanding and implementation of nail care responsibilities. While some staff stated that nail care should be performed on shower days or as needed, others indicated it was not part of their daily routine. There was also confusion regarding the facility's nail care policy, with some staff unaware of its specifics. Documentation showed that in-service training on resident hygiene had occurred, but recent staff turnover and the hiring of new CNAs may have contributed to lapses in care. Record reviews confirmed that both residents had care plans and assessments documenting their need for assistance with personal hygiene and nail care. However, observations and resident interviews on the day of the survey indicated that these interventions were not being consistently implemented, resulting in unmet hygiene needs for residents who were unable to care for themselves.