Failure to Provide Nail Care as Part of ADL Support
Penalty
Summary
The facility failed to provide adequate activity of daily living (ADL) care related to personal grooming for one resident who was dependent on staff for ADLs and mobility. The resident, who was cognitively intact and had diagnoses including osteoarthritis and depression, was observed on multiple occasions to have long, jagged fingernails with a brown/red substance present on and under the nails. The resident reported that staff did not offer nail care and expressed a preference for shorter nails. There was no documentation indicating that the resident refused nail care, and the care plan and CNA Kardex both specified that nail care should be performed on bath days and as needed, with any refusals or changes to be reported to nursing staff. Interviews with staff revealed that nail care was expected to be performed on bath days or sooner if needed, and that refusals should be documented and reported. However, the nurse interviewed was unsure where refusals would be documented, and the DON confirmed that nail care should be part of daily ADL care and refusals should be reported and documented. Despite these policies and expectations, the resident's nails remained untrimmed and uncleaned over several days, and there was no evidence in the medical record of nail care being provided or refused.