Failure to Provide Regular Nail Care for Dependent Resident
Penalty
Summary
The facility failed to provide regular nail care for one resident who was dependent on staff for activities of daily living due to multiple medical conditions, including cerebrovascular disease, cerebral palsy, diabetes mellitus, vascular dementia, muscle weakness, and contractures in both hands. The resident was assessed as having intact cognition and did not refuse care. Facility policy required that residents unable to perform ADLs receive necessary services to maintain personal hygiene, including routine cleaning and inspection of nails during ADL care. The resident's care plan specifically directed staff to check, trim, and clean nails on bath days and as needed. Despite these requirements, observations revealed that the resident's fingernails were long, dirty, and had debris underneath, with some nails having jagged edges. Interviews with staff indicated confusion regarding responsibility for nail care, particularly for diabetic residents. Some staff believed only nurses or a podiatrist could trim the nails, while others stated nurse aides were responsible for ADL care, including nail care, except for diabetic residents. The podiatrist only visited monthly and was reported to provide toenail, not fingernail, care. Nursing staff acknowledged the resident's nails needed trimming and confirmed the resident did not refuse care, but could not recall when nail care was last provided.