Failure to Provide Required Fingernail Care and Hygiene Assistance
Penalty
Summary
The deficiency involves the facility’s failure to maintain a resident’s personal hygiene by not providing routine fingernail care as required by facility policy and the resident’s care plan. The facility’s ADL policy states that residents unable to carry out activities of daily living will receive necessary services to maintain grooming and personal hygiene, including nail care. The resident’s MDS showed moderate cognitive impairment with a BIMS score of 10 and documented limited ability with ADLs, requiring assistance due to impaired cognition, general weakness, and pain related to Alzheimer’s disease, ulcerative colitis, and low back pain. The resident’s care plan required staff assistance with showering twice weekly, partial bathing twice daily, and assistance with hair, lotion, and nail care. On multiple observations, the resident was seen sitting in a wheelchair near the nurses’ station with fingernails that were jagged, untrimmed, and with brown material beneath them, despite documentation that the resident had recently received showers and bathing assistance. Staff interviews confirmed that shower aides are responsible for providing nail care, including cleaning under the nails with every shower and as needed, and that this care should have been provided during the resident’s most recent shower. One CNA acknowledged that the resident’s nails should have been cleaned and trimmed but “it doesn’t look like it was done.” Another CNA stated they documented the shower but did not provide it, and confirmed that nail care should have been done. The shower aide also confirmed the expectation that nail care be provided with each shower, indicating that the resident’s nail care was not completed as required.
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