Failure to Provide Required Assistance with Fingernail Care
Penalty
Summary
A deficiency was identified when a resident with a history of stroke, hemiplegia, and hemiparesis, who required substantial to maximal assistance with most activities of daily living (ADLs), did not receive adequate fingernail care. The resident's care plan directed staff to check, trim, and clean nails on bath days and as necessary, with documentation of any refusals. Despite these directives, observations on multiple occasions revealed the resident's fingernails were overgrown with dark debris underneath. The resident expressed a desire to have his nails cut and stated that staff assisted him with nail care. Documentation did not indicate that fingernail care was provided or refused, and staff interviews revealed inconsistent accounts regarding refusals and plans to address nail care. The facility's policy required daily cleaning and regular trimming of nails, with documentation of refusals and interventions. However, the resident's records, including the Treatment Administration Record and Weekly Bath Audit, did not reference fingernail care or refusals. Staff interviews confirmed that nail care was expected to be completed with weekly showers and as needed, but the resident's nails remained untrimmed and uncleaned over several days. The lack of proper documentation and follow-through on care plan directives led to the failure to provide necessary assistance with personal hygiene for the resident.