Failure to Provide Nail Care for Dependent Resident with Skin Conditions
Penalty
Summary
The facility failed to ensure that nail care was completed for a resident who was dependent on staff for activities of daily living (ADLs). The resident had multiple diagnoses, including Type 2 diabetes mellitus, dermatitis, prurigo, and a history of MRSA skin infection, and required staff assistance with ADLs. Observations over several days revealed that the resident's fingernails were excessively long, with a dark, brown substance underneath, and the resident had open lesions from scratching. Documentation showed no evidence that the resident refused nail care or assistance with cleaning under the nails during the review period, and there was a lack of progress notes indicating refusals or attempts to provide nail care. Interviews with nursing staff and nursing assistants confirmed that nail care for diabetic residents was the responsibility of licensed staff, while cleaning under the nails was to be performed by nursing assistants. Both groups acknowledged the importance of maintaining clean and trimmed nails, especially given the resident's history of skin infections and scratching. However, staff were unable to recall recent attempts to clean the resident's nails, and there was no documentation of refusals or completed care. The facility's policy for nail care was requested but not provided.