Failure to Provide Adequate Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically in maintaining good grooming and personal hygiene for two residents who were dependent on staff for care. Both residents had severe cognitive impairment and required maximum or extensive assistance with personal hygiene, as documented in their care plans and MDS assessments. On the day of observation, both residents were found with fingernails that were long, jagged, discolored, and had visible debris underneath. One resident expressed a desire to have her nails cleaned and trimmed, while the other was unable to participate in an interview but was observed looking at her fingernails. Interviews with staff, including CNAs, an RN, and the DON, confirmed that responsibility for nail care was shared between CNAs and nurses, with nurses specifically responsible for residents with diabetes. Staff acknowledged that nail care should be performed on shower days and as needed, and that dirty, untrimmed nails could pose an infection risk. Facility policy required nail care to be provided to keep nails clean and trimmed, with specific instructions for residents with certain medical conditions. Despite these policies and staff awareness, the necessary nail care was not provided to the two residents on the day of observation.