Failure to Provide Nail Care for Dependent Residents
Penalty
Summary
Surveyors identified a deficiency in the provision of activities of daily living (ADL) care, specifically related to nail care for dependent residents. Two residents with significant cognitive and physical impairments were observed to have long, jagged fingernails with unknown material underneath. One resident, with diagnoses including Alzheimer's dementia, Parkinson's disease, and diabetes, was noted to be dependent on staff for most ADLs and unable to communicate due to cognitive impairment. The other resident, with diabetes, rhabdomyolysis, and metabolic encephalopathy, required moderate assistance with ADLs and expressed a desire for nursing staff to provide nail care. During observations, both residents were found in clean, seasonally appropriate clothing, but their fingernails were visibly unkempt and dirty. The Director of Nursing confirmed the condition of the residents' nails, verifying that they were long, jagged, and in need of care. The failure to provide necessary nail care services was documented through direct observation, record review, and interviews, affecting two of three residents reviewed for care and services.
Plan Of Correction
Facility Name: Majestic Care of Middletown F0677 ADL Care for Dependent Residents State: Ohio Residents #32 and #100 identified during the survey were immediately assessed by the DNS/designee on 6/2/2025, revealing no negative outcomes related to the cited deficient practice. Both residents immediately received nail care by DNS/designee. A facility-wide audit was conducted by DNS/designee on 6/18/2025 - 6/20/2025 to identify residents who need ADL/nail care to ensure nails are clean and trimmed to the resident's preference. Residents' care plans were updated based on their personal preferences. Any discrepancies were corrected immediately by DNS/designee, and appropriate interventions were implemented. All nursing/CNA staff received in-service training on ADL care per policy requirements, with emphasis on nail care. The DON educated staff on 6/18/2025. The DNS/designee will audit 5 random residents weekly for 4 weeks, then once weekly for 2 months. All findings will be reported to the QA committee for review. The committee meets monthly and as needed. Completion Date: July 10, 2025