Failure to Provide Necessary Nail Care for Dependent Resident
Penalty
Summary
A deficiency was identified when a resident with a history of type 2 diabetes mellitus, muscle weakness, and cerebrovascular accident (CVA), who was severely cognitively impaired and required extensive two-person assistance for personal hygiene, was observed to have long, discolored fingernails with dark brown residue underneath. The resident's care plan specified that she depended on staff for all activities of daily living (ADLs), including nail care, and that licensed nurses were responsible for trimming the nails of diabetic residents. The care plan also included interventions for maintaining the resident's dignity by ensuring she was clean, dry, odor-free, and well-groomed. Despite these documented needs and interventions, staff interviews revealed a lack of communication and follow-through regarding the resident's nail care. CNAs stated they would notify a nurse about the need for nail care for diabetic residents, while the nurse interviewed was unaware of the resident's nail condition and had not been notified. The Director of Nursing confirmed that nail care should be performed as needed and during handwashing, with daily observation of nail condition. Facility policy also required that nail care be part of bathing and that nurses trim the nails of diabetic residents. The failure to provide necessary nail care resulted in the resident having long and dirty fingernails.