Failure to Provide Adequate Nail Care for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate assistance with personal hygiene and nail care to a resident who was dependent on staff for activities of daily living. The resident was admitted with multiple diagnoses including stroke, dementia without behaviors, type 2 diabetes mellitus, depression, anxiety, and polyneuropathy, and was documented on a quarterly MDS as cognitively impaired and dependent on staff for personal hygiene and toileting. The resident’s care plan identified a physical functioning deficit and included an intervention for nail care as needed. During an observation and interview, the resident’s fingernails were noted to extend approximately one eighth of an inch beyond the fingertips and were encrusted with a dark brown substance. The resident reported that staff had not offered to clean or trim his nails and stated he would like assistance with nail care. Further observations and staff interviews confirmed the lack of appropriate nail care. A CNA acknowledged that the resident’s fingernails were long and dirty and stated that another CNA had said she would take care of the nails. The CNA indicated she would clean the nails and notify a nurse that the resident’s nails needed to be cut, explaining that CNAs were not permitted to cut the nails of residents with diabetes. An LPN stated that the expectation was for CNAs to clean and trim residents’ nails during showers or bed baths, and that for residents with diabetes, it was the responsibility of a nurse or podiatrist to ensure nails were trimmed. A subsequent observation showed the resident’s fingernails were clean but still uncut. The facility’s ADL policy stated that residents unable to carry out ADLs independently would receive appropriate support and assistance with hygiene, including grooming, but this was not followed for this resident’s nail care.
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