Failure to Provide Routine Fingernail Care for Dependent Resident
Penalty
Summary
Facility staff failed to provide adequate fingernail care as part of grooming for one resident with severe cognitive impairment and total dependence on staff for personal hygiene. The resident, diagnosed with Alzheimer's Disease, non-Alzheimer's dementia, end stage renal disease, and other conditions, was observed with a brown-black substance under multiple fingernails on several occasions. The resident was seen licking her fingers and digging inside her brief, with the substance persisting under her nails despite staff attempts to wipe her fingers during peri-care. Documentation showed that nail care was not recorded as completed during multiple showers over a two-month period. Interviews with CNAs and nursing staff revealed inconsistent practices and unclear responsibility for nail care, with some staff believing it was handled by activities or environmental aides, and others stating it was done only if time allowed or if the resident requested it. The facility's nail care policy lacked specific direction on when nail care should be provided, and both the Assistant Director of Nursing and Director of Nursing confirmed that CNAs were expected to perform nail care during showers or baths and as needed. However, observations and documentation indicated this was not consistently done for the resident in question.