Failure to Provide Hand and Nail Hygiene for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident with metabolic encephalopathy, liver cancer, muscle weakness, and moderate cognitive impairment was observed with visibly soiled hands and brown-colored substance encrusted under the fingernails of both hands. The resident required moderate assistance with personal hygiene and was frequently incontinent of bowel and bladder. The care plan and Kardex specified that nail care should be provided on bath days and as necessary, but there was no documentation in the electronic medical record (EMR) or progress notes regarding fingernail or hand hygiene. The resident's care plan also indicated a need for one-person staff assistance with personal hygiene, and there was no documentation of the resident refusing care related to hand or fingernail hygiene. During interviews, the resident reported not receiving help with hand hygiene, and a CNA confirmed that while the resident sometimes refused care, there was no recollection of refusals related to hand and fingernail hygiene. The CNA was unaware of the resident's soiled hands and nails until prompted and acknowledged that the hands and fingernails would be cleaned immediately. The facility's policy required that residents unable to perform activities of daily living independently receive necessary services to maintain grooming and personal hygiene, but this was not followed in this instance.