Failure to Provide Adequate ADL Assistance for Hygiene and Nail Care
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADL) for two residents who were unable to perform these tasks independently. One resident was repeatedly observed with long, dirty, and untrimmed fingernails as well as unkempt facial hair. The resident confirmed not being offered shaving or nail care, even on scheduled shower days, and expressed a desire for these services, noting that prior to admission, facial hair was kept neat. The care plan indicated the resident required assistance with all ADLs due to generalized weakness, but staff did not ensure the resident was added to the barber list or provided with nail care. Both the unit manager and DON acknowledged that CNAs and nurses were responsible for providing and verifying completion of these ADL tasks on shower days, but this was not done. Another resident was observed multiple times with long fingernails containing visible debris and reported being unable to cut their own nails, preferring them short. The resident's medical record showed a diagnosis of cerebral palsy and a need for substantial to maximal assistance with ADLs, with no documentation of refusals for care. The care plan lacked specific interventions for nail care, and staff interviews confirmed that nails should be trimmed and cleaned according to resident preferences. Facility policy required routine cleaning and inspection of nails during ADL care, but this was not consistently implemented, resulting in the residents' unkempt appearance.