Failure to Provide ADL Care and Assistance with Eating
Penalty
Summary
The facility failed to provide adequate activities of daily living (ADL) care, specifically fingernail care, for three residents who were dependent on staff for personal hygiene. One resident with severe cognitive impairment and physical limitations was observed with excessively long fingernails, some with dark sediment underneath, and a contracted hand where a fingernail had caused an injury by digging into the palm. Staff interviews revealed confusion about responsibility for fingernail care, with some staff believing only the podiatrist or nurses could trim nails, especially for residents with diabetes. Documentation of attempted nail care was lacking, and the injury to the resident's hand was not identified until brought to staff attention by the surveyor. Another resident, who was cognitively intact but dependent on staff for personal hygiene, was also observed with very long fingernails containing brown and black sediment. The CNA assigned to her care stated she did not trim nails for diabetic residents and did not report the need for nail care to a nurse manager. This resident was also known to put her fingers in her feces, further highlighting the need for regular and thorough nail and hand hygiene, which was not provided. A third resident with cognitive impairment and physical limitations was observed with long fingernails, contracted fingers, and crusted patches of skin on her palm. She required maximum assistance for personal hygiene, but staff reported difficulty finding nail clippers and inconsistent provision of nail care. Additionally, a separate concern was identified regarding a resident who required assistance with eating. Despite documented grievances from her spouse and a care plan indicating the need for setup or clean-up assistance, the resident was observed alone with an untouched meal and unable to access her drink, indicating a lack of timely assistance with eating.