Failure to Provide Routine Nail Care for Dependent Residents
Penalty
Summary
The facility failed to ensure that routine nail care was provided for two residents who required assistance with activities of daily living (ADLs). One resident, with a history of bipolar disorder, anxiety, contractures, heart disease, neuropathy, and a recent finger fracture, was observed to have long, discolored, and jagged fingernails on a contracted hand. The care plan noted the resident's risk for skin breakdown and a tendency to scratch, but did not include specific interventions for nail care or alternative plans to address nail maintenance. The resident expressed concern about the condition of his nails, noting they were curling under, and agreed to have them trimmed when offered by staff. Documentation did not reflect consistent nail care assistance as part of his ADL support. Another resident, diagnosed with dementia, arthritis, gout, heart failure, and other chronic conditions, was observed with long, unclean fingernails and stated she needed her nails done. The care plan indicated that nail care should be provided on bath days and as necessary, but review of shower documentation showed the last shower occurred a week prior, with no record of nail care being completed. Staff confirmed that nail care was expected to be performed during showers, but there was no evidence this was done. The facility was unable to provide a nail care or shower policy upon request during the survey.