Failure to Provide and Document Required Nail Care for Two Dependent Residents
Penalty
Summary
The facility failed to provide adequate ADL nail care for two residents who required assistance. For one resident with COPD, Parkinson’s disease, ataxia, and tremors, surveyors observed orange and brown buildup under the nails. The resident’s 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, and may need limited to extensive assistance by one or two staff. Review of progress notes showed no documentation of refusal of ADLs, including nail care. Shower sheets indicated scheduled showers on Wednesdays and Saturdays, with multiple dates where nail care was neither documented as provided nor refused. On one date, nail care was initially marked as completed, then crossed out and changed to refused by a CNA. In interview, the CNA stated that when the resident refuses nail care, they contact the family to help convince the resident, and that nail care would be provided on non-shower days if needed, with shower sheets completed for each attempt. 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 separate days. The MDS indicated the resident was unable to complete the BIMS interview and showed no rejection-of-care behaviors. 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 by one or two staff. Progress notes contained no documentation of refusal of nail care. Shower sheets showed scheduled showers on Wednesdays and Saturdays, with dates where nail care was not documented as provided or refused. An LPN stated that shower sheets are to be completed for any hygienic care and refusals for each attempt and that this resident usually does not refuse care. The unit manager and DON acknowledged that both residents’ care plans should have been updated to reflect frequent nail care needs, and the DON stated that hygienic care is expected even on non-shower days and that the second resident’s nails were not acceptable and should have been addressed, consistent with the facility’s ADL Care and Services policy that includes nail care.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.