Failure to Provide Adequate Nail Care for Two Residents
Penalty
Summary
Surveyors identified that the facility failed to provide adequate nail care for two residents who were sampled for activities of daily living (ADLs). One resident was observed multiple times with fingernails extending 1/3 to 1/2 inch past the fingertips, discolored, and with a dark substance present. The resident reported not wanting long fingernails and stated that staff had not offered to cut them, with documentation showing nail care was only provided eight out of twenty-seven days. The resident's care plan indicated a self-care performance deficit related to weakness and activity intolerance, as well as impaired cognitive function due to dementia, but did not address any behaviors related to refusing care. Staff interviews confirmed that nail care should be provided by CNAs or nurses, with special consideration for diabetic residents. Another resident was observed with long fingernails and a dark brown substance caked underneath. This resident expressed a preference for regular nail care and reported that staff did not mention or offer to cut fingernails, and that toenail care was only provided once every two months. The resident indicated willingness to perform self-care if supplies were available. Documentation revealed several days where nail care was not provided, and shower logs were incomplete for the requested period. Staff interviews indicated that refusals for ADL care were not consistently documented with reasons, and that ADL care may not be provided when CNAs are assigned to other duties. The facility's care plan for one resident instructed staff to check and trim nails on bath days and as necessary, but records showed this was not consistently done. The facility lacked a specific ADL policy, and the process for documenting refusals was not always followed according to the facility's own declination form. Photographic evidence was obtained to support the findings.