Failure to Provide Timely Incontinence and Nail Care for Dependent Residents
Penalty
Summary
Surveyors identified that staff failed to provide routine and appropriate incontinence care and maintain fingernail hygiene for residents dependent on staff for activities of daily living. One resident was repeatedly observed with long, jagged fingernails containing a black substance underneath, despite being alert, requesting nail care, and having a scheduled weekly shower. The resident's care records did not include a physician's order for fingernail care, and nail care was not completed during the scheduled shower. Another resident reported not receiving incontinence care or being repositioned since the previous night, resulting in the resident being found saturated with urine and lying in soiled bedding. The resident, who was cognitively intact and required assistance with personal hygiene, stated that staff did not respond to their call light. The CNA assigned to the resident was unaware of the lack of care due to not receiving a shift report, and the unit was short-staffed due to a call-out, with each CNA responsible for 23 residents. A third resident, who was nonverbal and totally dependent on staff, was found with contracted extremities, saturated with urine, and wearing two incontinence briefs, both soaked. The resident's dressing was also saturated with urine and bloody drainage. The CNA responsible for the resident confirmed placing two briefs on the resident and could not recall when the resident was last changed. Staff interviews confirmed that incontinence care was expected every two hours, but staffing shortages impacted care delivery. Facility policy required individualized ADL care, including regular incontinence care and maintaining resident dignity and hygiene.