Failure to Provide Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically nail care, for two residents who were dependent on staff for personal hygiene. One resident, a female with diabetes, dementia, and generalized muscle weakness, was found to have long fingernails and expressed that she wanted them trimmed but was unable to do so herself. Her care plan did not address ADLs, and there was no documentation of her being resistive to care. Another resident, a male with multiple diagnoses including heart failure, diabetes, cerebrovascular accident, and renal insufficiency, was observed with long, jagged, and dirty fingernails. He also stated he wanted his nails trimmed and had previously requested this from staff, but the care was not provided. Interviews with staff confirmed that both CNAs and nurses were responsible for nail care, and that nail care should be provided on shower days and as needed, including for residents on hospice. Staff acknowledged that neither resident had a history of refusing nail care, and that the observed conditions of the residents' fingernails were not in accordance with facility policy, which requires daily cleaning and regular trimming. The Director of Nursing and other staff confirmed that the residents' nails should have been trimmed and cleaned, and that the lack of care was not due to resident refusal.