Failure to Provide Necessary Nail Care During ADL Assistance
Penalty
Summary
A deficiency was identified when a resident with severe cognitive impairment and multiple complex medical diagnoses, including chronic respiratory failure, severe protein-calorie malnutrition, and hypertensive heart disease, did not receive necessary assistance with activities of daily living (ADLs), specifically nail care. The resident required moderate assistance with personal hygiene and was unable to perform these tasks independently. During an observation, the resident was found to have long fingernails with a large amount of brown substance underneath, and the resident reported having requested nail care from staff the previous week, which was not provided. Review of documentation indicated that ADL care, including nail care, was recorded as completed, but interviews with the CNA responsible for the resident's care confirmed that the CNA did not clean or cut the resident's fingernails during the documented ADL care. Both the treatment nurse and the Director of Nursing acknowledged that the resident's nails should have been cleaned as part of routine ADL care, and that this was not done.