Failure to Provide Assisted Nail Care for Dependent Resident
Penalty
Summary
Surveyors identified that a resident with schizophrenia, a mental health disorder, and severely impaired cognition did not receive adequate and timely assistance with personal hygiene, specifically nail care, despite being dependent on staff. The resident’s MDS assessment showed he required moderate assistance with personal hygiene and did not reject care. His functional ability care plan documented that he needed assistance with self-care due to impaired cognition and mobility, and included an intervention to keep his fingernails trimmed and clean, with a designation that he required substantial or maximal assistance with personal hygiene. A cognitive care plan also noted his severely impaired cognition and included a goal to anticipate his needs based on past preferences. On two consecutive days, surveyors observed the resident’s fingernails to be long and jagged. The resident’s spouse/representative reported that the resident preferred to keep his fingernails short and trimmed. An LPN and the unit manager both confirmed that the resident’s fingernails were long and jagged, and the unit manager stated that the resident was cooperative with grooming and nail care. Facility policy on Standards of CNA Practice indicated that CNAs, under licensed nurse supervision, are responsible for assisting residents with ADLs, including grooming and nail care. The failure to maintain the resident’s fingernails in accordance with his care plan and stated preferences constituted the deficiency.
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