Failure to Provide Scheduled Nail Care and Bathing
Penalty
Summary
The facility failed to provide adequate nail care for a resident with diabetes and severe cognitive impairment. Observations over several days revealed that the resident's fingernails were excessively long and had a dark, brown substance underneath, which staff described as appearing to be feces and dirt. Interviews with CNAs and an LPN confirmed that nail care was inconsistently provided, with no clear schedule or documentation for weekly nail care by licensed staff, despite the resident's care plan indicating a need for regular nail checks and cleaning. The resident's records did not show any refusal of care, and there was no order for weekly nail care in the electronic Medication Administration Record or treatment record. Additionally, the facility failed to ensure that another resident received scheduled baths or showers after admission. The resident reported not having had a bath since admission, and review of the ADL/bath record confirmed that no showers were documented as given according to the resident's scheduled days. Staff interviews revealed confusion about the resident's shower schedule and documentation, with CNAs indicating that new admissions should receive showers promptly but unable to explain why this resident had not received one as scheduled. The DON and Administrator both acknowledged that the resident should have received a bath or shower earlier, but this did not occur. Both deficiencies were observed through direct observation, interviews with staff and residents, and review of facility records and policies. The facility's own policies required regular nail care and scheduled bathing to promote hygiene and comfort, but these were not followed for the residents involved.