Failure to Notify Physician and Responsible Party of Residents' Refusal of Nail Care
Penalty
Summary
The facility failed to meet professional standards of practice for two residents when staff did not notify the physician or the resident's responsible party (RP) after the residents refused nail care. In the case of one resident with severe cognitive impairment and multiple complex medical diagnoses, including traumatic brain injury and major depressive disorder, the resident was observed with long, thick, and jagged toenails with a dark crusted substance underneath. Staff interviews revealed that although the need for nail care was identified, there was no documentation of refusal or notification to the physician or RP, and the resident's care plan for non-compliance was not initiated until months after the initial refusal. Another resident, who was cognitively intact and had a history of schizophrenia, pain, muscle weakness, anxiety, and depression, was also observed with long, jagged fingernails and toenails. The care plan for this resident included interventions for notifying the physician and RP in the event of non-compliance, but there was no documentation that these notifications occurred following the resident's refusal of nail care. Staff interviews confirmed that refusals and notifications were not consistently documented, and the only recorded attempt to notify the RP was from a previous year. Throughout the investigation, staff including CNAs, nurses, the Director of Staff Development, and the Interim Director of Nursing acknowledged that proper nail care is important for resident comfort and infection prevention, and that refusals of care should be documented and communicated to the physician and RP. However, the records reviewed showed a lack of documentation and follow-through on these procedures, resulting in the deficiency.