Failure to Provide Adequate Nail Care and Personal Hygiene Assistance
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living (ADLs), specifically grooming and personal hygiene, for four residents who were dependent on staff for these tasks. Observations and interviews revealed that these residents had long, dirty, and untrimmed fingernails, with some nails being thickened, jagged, or discolored. In several cases, residents expressed a desire to have their nails trimmed and cleaned, and staff acknowledged that nail care had not been performed as needed. Resident records indicated that all four residents had significant cognitive and/or physical impairments, such as hemiplegia, contractures, diabetes, and severe cognitive deficits, requiring substantial or total assistance with personal hygiene. Care plans for these residents specified the need for staff assistance with nail care, yet observations showed that this care was not consistently provided. Staff interviews confirmed that nail care was a shared responsibility between CNAs and nurses, with some staff noting that nail care should be offered during routine hygiene or as needed, and that certain residents had a history of refusals, though this was not always documented or addressed. The facility's own policy required regular cleaning and trimming of fingernails, but this was not followed for the residents in question. Staff interviews further revealed a lack of consistent monitoring and follow-through, with some CNAs stating they had not noticed the condition of the residents' nails during their rounds. The DON and ADON acknowledged that nail care should be performed regularly and that lapses could pose infection control issues, but the deficiency persisted as observed during the survey.