Failure to Provide ADL Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide adequate assistance with activities of daily living (ADLs), specifically in the area of fingernail care, for two residents who required substantial or maximal assistance due to severe cognitive impairment and other medical conditions. Observations revealed that both residents had dirty fingernails with visible debris, and one resident expressed a desire for his nails to be cleaned and cut. Record reviews indicated that both residents had care plans and assessments documenting their need for assistance with personal hygiene, including grooming and nail care, due to diagnoses such as Alzheimer's disease, dementia, diabetes, and muscle weakness. Interviews with facility staff, including the ADON, DON, and Administrator, confirmed that nursing staff and CNAs were responsible for monitoring and providing nail care, with nurses specifically assigned to diabetic residents. However, it was acknowledged that there was no system in place to monitor or ensure that nail care services were consistently provided. Facility policy required assistance with ADLs, including grooming, every shift as appropriate, but this was not followed for the two residents identified in the report.