Failure to Provide Necessary Nail Care During ADL Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary daily grooming assistance, specifically nail care, for residents who were unable to perform this activity of daily living themselves. For one resident with major depressive disorder, dementia, and epilepsy, surveyors repeatedly observed long, dirty, chipped, and jagged fingernails over multiple days, despite documentation that the resident had received several showers during the same period. The resident’s MDS showed moderate cognitive impairment and a need for partial/moderate assistance with personal hygiene, and the care plan indicated he required physical assistance with ADLs and bathing due to dementia and schizophrenia. Nonetheless, his nails remained untrimmed and uncleaned across several observations. Another resident with cerebral palsy, profound intellectual disabilities, aphasia, severe cognitive impairment, and functional limitations in both upper and lower extremities was observed with tan dried substance under seven of ten fingernails. Her care plans documented total assistance by two staff for a.m. and p.m. care and included interventions such as manicures during 1:1 programming. Staff interviews revealed inconsistent practices and understanding regarding nail care: CNAs and nursing staff variously stated that nail care was done on shower days, on an as-needed basis, or only when residents requested it, and that nail care was not documented. The DON and facility policy indicated nail care was to be provided as needed and checked on shower days, but the observed condition of the two residents’ fingernails and the lack of documentation showed that necessary nail care was not consistently provided.
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