Failure to Provide Adequate Fingernail Care for Dependent Resident
Penalty
Summary
The facility failed to provide adequate fingernail care for a resident who was dependent on staff for activities of daily living (ADLs) due to severe cognitive impairment and multiple medical diagnoses, including senile degeneration of the brain and anxiety disorder. Despite care plan interventions that included negotiating care times and re-approaching the resident if care was initially refused, there was no documentation in the medical record or shower sheets indicating that the resident refused fingernail care or that her fingernails were long and dirty. Observations on multiple occasions revealed the resident had long fingernails, measuring about half to three-quarters of an inch, with dark brown material underneath. Certified Nurse Aides (CNAs) confirmed the condition of the resident's fingernails and expressed uncertainty about whether fingernail care should be performed during bathing. Interviews with staff, including the Director of Nursing (DON), revealed that CNAs were expected to check and document fingernail care needs on bath days and report issues to the nurse, who was responsible for trimming fingernails. However, there was no evidence that this process was followed, as the nurse was not informed of the need for fingernail care, and the issue was not documented. The facility's policy required staff to provide necessary services for personal hygiene, but this was not adhered to in the case of this resident, resulting in inadequate fingernail care.