Failure to Update Care Plans and Provide Ongoing Nail Hygiene Care
Penalty
Summary
The deficiency involves the facility’s failure to update and implement comprehensive care plans to address ongoing nail and hygiene care needs for two residents. Facility policy requires that comprehensive care plans be reviewed and revised by the interdisciplinary team after each MDS assessment and that services in the care plan be provided by qualified staff. For one resident with COPD, Parkinson’s disease, ataxia, and tremors, surveyors observed orange and brown buildup under the nails. The resident’s quarterly MDS showed severe cognitive impairment with no documented rejection of care, and the care plan identified an ADL self-care deficit related to Parkinson’s disease, indicating the resident should be encouraged and assisted with all ADLs, including personal hygiene, with limited to extensive assistance. Progress notes contained no documentation of refusal of ADLs, including nail care, and shower sheets for multiple dates showed no nail care documented or refused, with one instance where nail care was initially marked as completed, then crossed out and changed to refused. For the second resident, who had Type 2 diabetes, COPD, and hypertensive heart disease, surveyors observed brown and dark-colored buildup under the nails on two occasions. The resident’s quarterly MDS indicated they were unable to complete the BIMS interview and showed no documented rejection of care. The care plan documented an ADL self-care deficit and the need for encouragement and assistance with all ADLs, including personal hygiene, with dependent assistance from one or two staff. Progress notes showed no documentation of refusal of nail care, and shower sheets for multiple dates showed no nail care documented or refused. Staff interviews revealed that shower sheets are supposed to be completed for all hygienic care and refusals, that nail care should be provided on non-shower days if needed, and that both residents’ care plans should have been updated to reflect the need for frequent nail care. The DON confirmed the expectation that hygienic care be provided even on non-shower days and acknowledged that the residents’ nails were not acceptable and that their care plans should have been updated to reflect frequent nail care needs.
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