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 grooming and personal hygiene, for four residents who were unable to perform these tasks independently. Observations and interviews revealed that multiple residents had excessively long, dirty, and untrimmed fingernails, despite being dependent on staff for personal hygiene. In several cases, residents expressed dissatisfaction with the state of their nails and reported that staff had not offered or provided nail care. For example, one resident with hemiplegia and a history of stroke was found with nails up to 1.5 inches long and a brown/black substance under her nails, and she stated that her sister, not staff, last trimmed her nails. Staff interviews indicated confusion or lack of awareness regarding responsibility for nail care. Certified Nursing Assistants (CNAs) and nurses gave inconsistent accounts of who was responsible for trimming nails, with some stating it was done on shower days or as needed, and others indicating that restorative aides or the staffing coordinator were also responsible. In some cases, staff admitted they had not noticed the residents' nail conditions or had not reported refusals or missed care to supervisors. One staff member stated she assumed others would take care of nail trimming if she was unable to do so. Record reviews showed that care plans for some residents did not include specific interventions for personal hygiene or nail care, despite documentation of self-care deficits and the need for assistance. Facility policy required daily cleaning and regular trimming of nails to prevent infection, but this was not consistently implemented. The Director of Nursing and other staff acknowledged that assigned individuals were responsible for ensuring nails were kept clean and trimmed, but residents were still found with long, dirty nails during the survey.