Failure to Provide Nail Care to Dependent Residents
Penalty
Summary
The facility failed to provide adequate nail care to dependent residents, as evidenced by observations, interviews, and record reviews. One resident with multiple medical conditions, including vertebral fractures, malnutrition, and cognitive communication deficits, reported not receiving nail care since admission. He stated he had to rip off his own fingernails, which were observed to be jagged, with sharp edges and dark debris underneath, and his toenails were also long. Staff interviews confirmed that nail care had not been provided, and the LPN indicated that nail care was only performed in the activity room and not in individual rooms unless residents were on a locked unit. The facility's policy required daily cleaning and regular trimming of nails, with documentation of care provided, but this was not followed for the resident. Another resident with a history of dementia, diabetes, and psychiatric disorders was observed to have very long toenails and reported not having seen a podiatrist for nail care since admission. Review of facility records confirmed the resident was not on the podiatry list, and the DON verified that no ancillary services had been provided since admission. The resident's care plan included interventions for nail care on bath days and as necessary, but these interventions were not implemented. These findings demonstrate a failure to provide necessary assistance with activities of daily living, specifically nail care, for residents who were dependent on staff for this aspect of personal hygiene.