Failure to Provide Adequate Nail Care for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident with Alzheimer's disease and left-sided weakness, who was severely cognitively impaired, did not receive necessary assistance with activities of daily living (ADLs), specifically nail care. The facility's policy required daily observation and trimming of nails as appropriate, and the resident's care plan included staff responsibility for maintaining nail hygiene. Despite this, observations on multiple occasions revealed the resident had long, dirty fingernails with a black substance underneath most nails. Documentation showed the last recorded nail care was several weeks prior to the observations, and staff interviews confirmed that nail care was typically provided during showers, but there was no evidence it was consistently performed for this resident. Interviews with staff, including a State Registered Nurse Aid (SRNA), a Registered Nurse (RN), the Director of Nursing (DON), and the Administrator, revealed an expectation that staff check and provide nail care daily. However, the resident continued to be observed with untrimmed and dirty nails, indicating a failure to follow facility policy and the resident's care plan. The family member of the resident also expressed dissatisfaction with the resident's nail hygiene, noting that the facility was usually attentive to this need. The deficiency was based on direct observation, record review, and staff and family interviews.