Failure to Provide Required Nail Care as Part of ADL Services
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate nail care as part of activities of daily living (ADLs) for one resident, contrary to its own policies on Nail Care and ADLs. The Nail Care policy required routine cleaning and inspection of nails during ongoing ADL care, with nails kept smooth to avoid skin injury and specific provisions for residents with diabetes. The ADL policy required that residents unable to carry out ADLs receive necessary services for grooming and personal hygiene, based on their assessment and care plan. The resident’s care plan directed staff to provide nail care as needed. The resident involved had a history of hemiplegia and hemiparesis following cerebrovascular disease, cerebellar stroke syndrome, type 2 diabetes mellitus, and major depressive disorder, and had severe cognitive impairment with a BIMS score of 3. The MDS indicated the resident required partial to moderate staff assistance with personal hygiene. On observation, the resident was seen in a wheelchair with fingernails on both hands extending approximately one-half inch past the fingertips, with yellow tint and brown matter under the nails on the left hand, and a black middle fingernail and white discoloration on the fifth fingernail of the right hand. The resident stated staff never asked to cut their nails and that they wanted staff to cut them. Progress notes from a ten-day period showed no documentation that the resident refused nail care. A CNA who provided a bed bath reported not cleaning or trimming the resident’s nails, and another CNA who checked off nail care on a shower sheet stated that this meant only cleaning the nails and that he did not notice if they needed cutting. An LPN stated neither the resident nor CNAs informed her that nail trimming was needed and that she did not notice the need herself. The unit manager, upon observing the nails, described them as thick, overgrown, and discolored and stated staff should have taken care of them. The DON and Administrator both stated expectations that CNAs clean nails during bathing and that staff provide nail care when giving showers, when requested, or as needed, which had not occurred for this resident as required by policy and the care plan.
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.