Failure to Maintain Resident Nail Hygiene
Penalty
Summary
A deficiency was identified when a resident with hemiplegia, hemiparesis, dementia, and end stage renal disease was observed to have lengthy and unclean fingernails with a dark brown substance underneath. The resident was severely cognitively impaired and dependent on staff for activities of daily living, including personal hygiene and nail care. Facility documentation and care plans indicated that the resident required total assistance with bathing and nail hygiene, and that nail care was to be performed weekly during scheduled showers. Despite these requirements, multiple observations over several days revealed that the resident's fingernails remained untrimmed and unclean, with one lengthy thumbnail pressing into the side of another finger on a contracted hand. Interviews with nursing staff and nurse aides revealed that nail care was not consistently provided due to staff being too busy or unclear about responsibility for the task. Nurse aides acknowledged seeing the resident's long and dirty nails and reported the issue to nursing staff, but did not address it during their shifts. The Director of Rehab confirmed that the resident was unable to perform nail care independently and that nursing staff had been informed of the need for regular nail maintenance due to the risk of skin breakdown. Facility policy required individualized assistance with daily care, including nail hygiene, but this was not followed for the resident in question.