Failure to Maintain Resident Nail Hygiene During ADL Assistance
Penalty
Summary
Staff failed to provide adequate assistance with activities of daily living (ADL) for a resident who was dependent on staff for personal care due to multiple diagnoses, including dementia, hemiparesis following a stroke, Parkinson's disease, and muscle weakness. The resident's medical record and care plan documented severe cognitive impairment and a need for staff assistance with bathing, toileting, oral hygiene, and dressing. Despite these needs, observations on multiple occasions revealed that the resident's fingernails had a dark brown substance underneath, indicating they were not being kept clean. Interviews with facility staff confirmed that CNAs are responsible for cleaning residents' fingernails during showers or bed baths, and that all staff are expected to monitor nail cleanliness. The facility's policy emphasized promoting cleanliness during bathing and showering. However, the repeated observations of dirty fingernails demonstrated that staff did not consistently ensure the resident's fingernails were clean, resulting in a failure to meet the resident's ADL needs as outlined in their care plan.