Failure to Provide Needed Nail Care for Dependent Resident
Penalty
Summary
The facility failed to provide necessary personal hygiene services to a resident who was dependent on staff for assistance with activities of daily living (ADLs), specifically in maintaining clean and trimmed fingernails. The resident, who had a history of type 2 diabetes mellitus, muscle weakness, osteoarthritis, and cancer, was assessed as having moderate cognitive impairment and required substantial to maximal staff assistance for personal hygiene. Despite facility policy requiring staff to assist residents unable to perform their own ADLs, multiple observations over several days showed the resident's fingernails remained long, jagged, and unclean. Family members confirmed that the resident's nails needed trimming and expressed that they expected the facility to provide this care. Interviews with CNAs and nursing staff revealed confusion regarding responsibility for nail care, particularly for residents with diabetes. CNAs stated they were responsible for nail care on shower days unless the resident had diabetes, in which case the nurse was to be notified. However, the resident's assigned CNA had not noticed the condition of the nails and had not provided the necessary care, while the nurse had not been alerted to the need. The DON and Administrator both stated their expectation that residents' nails be kept clean and trimmed as allowed, but the resident continued to have untrimmed and unclean nails throughout the period of observation.