Failure to Provide Necessary Nail Care for Dependent Resident
Penalty
Summary
A deficiency occurred when a resident with significant physical impairments, including hemiplegia, hemiparesis, Parkinson's disease, and diabetes mellitus, did not receive necessary fingernail care. The resident was unable to open her left hand due to contracture and required assistance with activities of daily living, including personal hygiene. Despite being scheduled for nail care by a licensed nurse twice a week, observations on multiple occasions revealed that the resident's left thumb nail was long and had rough edges. The resident expressed a desire for her nails to be trimmed and denied refusing nail care. Interviews with staff revealed confusion and lack of clarity regarding responsibility and procedures for nail care, especially for diabetic residents. CNAs reported that they could not trim the resident's nails due to her diabetes and contracture, and stated they would report concerns to the nurse. Licensed nurses, including LVNs and RNs, acknowledged the importance of nail care but were either unaware of the resident's need, unsure of the schedule, or did not know where to document the care provided. The DON and ADON confirmed that nail care for diabetic residents should be performed by nurses and expected it to be done promptly when needed, but there was inconsistency in staff knowledge and execution of these expectations. The facility's policy required routine cleaning, inspection, and trimming of nails by nurses for diabetic residents, with documentation in the care system. However, the care plan for the resident did not address nail care, and there was no physician order for it. Multiple staff members, including the administrator, were unaware of the specific requirements for diabetic residents' fingernail care and the frequency of checks. This lack of coordination and adherence to policy resulted in the resident not receiving necessary nail care, as evidenced by repeated observations of long, untrimmed nails and staff interviews confirming the deficiency.