Failure to Provide Adequate Personal Hygiene and Nail Care
Penalty
Summary
The facility failed to provide necessary care and services to maintain proper grooming and personal hygiene for a resident who was dependent on staff for activities of daily living (ADLs), including bathing and fingernail care. The resident, who had a history of osteomyelitis, necrotizing fasciitis, pressure ulcers, and complete paraplegia, was documented as being dependent on staff for oral hygiene, toileting, showering/bathing, dressing, and personal hygiene. Despite this, observations over several days revealed that the resident's fingernails were excessively long and had a black substance underneath, and the resident confirmed needing assistance with nail care. Staff interviews confirmed that nail care was the responsibility of nursing assistants and should be performed as needed, but the assigned staff could not recall the last time nail care was provided and acknowledged the resident's nails needed attention. Documentation showed inconsistent and infrequent bathing, with records indicating only a few bed baths or showers provided over several months, and some refusals or days marked as not applicable. However, staff interviews and observations indicated that the resident did not consistently refuse care, and when care was refused, it was not always properly documented or reported. Nursing assistants and supervisory staff acknowledged that the resident had not received daily bed baths or complete hygiene care, including washing of legs and feet and removal of socks for skin inspection, as expected by facility policy. Supervisory staff, including the ADON, DON, and clinical manager, confirmed that the resident's hygiene and grooming needs were not met according to facility expectations and policy. They agreed that the resident's nails were in poor condition and that daily bathing and complete hygiene care, including nail care, should have been provided. The lack of consistent documentation, failure to offer or provide daily hygiene care, and inadequate attention to the resident's grooming needs led to the deficiency identified during the survey.