Failure to Provide Timely Nail and Incontinence Care
Penalty
Summary
Staff failed to provide adequate fingernail care for two residents who were dependent on staff for personal hygiene. One resident with dementia and chronic medical conditions was observed on multiple occasions to have very long fingernails with dark debris underneath, despite physician orders and care plans directing weekly nail assessments and care on shower days. Interviews with staff confirmed that nail care was their responsibility and there was no directive from the family to restrict staff from performing this care. Similarly, another resident with Alzheimer's disease and limited mobility was observed to have long, dirty fingernails, and reported having requested nail care from staff without receiving it. Staff interviews confirmed that nail care should be performed on shower days or as needed, and facility policy supported this expectation. In a separate incident, a resident with cerebellar ataxia, epilepsy, functional quadriplegia, and a feeding tube, who was fully dependent on staff for all ADLs and incontinent, was left without timely assistance after being incontinent. The resident was observed calling for help for approximately an hour, using the call bell multiple times, and communicating the need for incontinence care. Staff responded through the intercom but did not enter the room or provide assistance for an extended period, with one staff member stating the resident would need to wait due to other duties. When care was finally provided, the resident was found to have a wet brief. Interviews with staff revealed a lack of communication and follow-through to ensure the resident's needs were met, despite care plans and policy requiring incontinence care every 2-3 hours and as needed. These deficiencies were identified through direct observation, review of clinical records, facility documentation, and staff interviews. The facility's own policies and care plans outlined the required standards for nail and incontinence care, but these were not consistently followed, resulting in unmet care needs for the residents involved.