Failure to Provide Nail Care for Dependent Residents
Penalty
Summary
The facility failed to provide adequate nail care for three residents who were dependent on staff for personal hygiene. One resident, admitted with heart disease and weakness, was observed with long fingernails and a dark brown substance under his nails. He reported receiving showers or bed baths but stated that staff did not clean under his nails or trim them, and he did not like having long, dirty nails. The nurse aide assigned to him confirmed that she had not noticed the condition of his nails and had not been informed by the resident that his nails needed attention. Facility leadership, including the DON and Administrator, stated that nail care should be performed with each shower and as needed. Another resident, admitted with a right humerus fracture, stroke, and hemiplegia, was also found with fingernails extending approximately 1/4 inch beyond the fingertips. He stated his nails had not been trimmed since admission and expressed a preference for short nails. The nurse aide responsible for his care was unaware of the length of his nails and had not provided nail care, stating the resident had not requested it. Interviews with nursing leadership reiterated that nurse aides are responsible for nail care during showers and as needed. A third resident, with diagnoses including diabetes, kidney failure, and muscle weakness, was observed with long fingernails and a brown substance underneath. He reported having asked staff to trim his nails without result and stated that nurse aides would not trim his nails due to his diabetes. The nurse aide confirmed she did not perform nail care for diabetic residents and would have reported long nails to a nurse if noticed. The ADON stated that the activity director, who normally performed nail care, had been absent, and that nurse aides should have reported the need for nail care to nursing staff. The DON was not aware that this resident's nails had not been trimmed.