Failure to Provide Fingernail Care During ADL Assistance
Penalty
Summary
A deficiency was identified when a resident, admitted with diagnoses including palliative care, breast cancer, chronic systolic heart failure, and atrial flutter, was observed to have lengthy and soiled fingernails with brownish debris under the nails on multiple occasions. The resident was documented as being dependent on staff for personal hygiene and had an ADL self-care performance deficit, requiring extensive assistance with personal hygiene as per the care plan. Despite a physician order for weekly skin inspections and a care card directing regular bathing or bed baths, records indicated that a bed bath was signed off as completed, yet the resident's fingernails remained unclean and untrimmed. Staff interviews revealed that nail care, including cleaning and trimming, was expected to be performed during bed baths or as needed, regardless of scheduled bath days. Supplies for nail care were available, and facility policy required assistance with ADLs to maintain grooming and hygiene for residents unable to perform these tasks independently. However, the observed condition of the resident's fingernails indicated that this care was not provided as required.