F0677

D

Failure to Maintain Resident Nail Hygiene and ADL Care

Denison, Texas Survey Completed on 12-18-2025

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide necessary ADL services to maintain grooming and personal hygiene for a resident who was dependent on staff for care. The resident was an elderly male with a history of cerebrovascular accident, type 2 diabetes, and PTSD, and his MDS assessment documented severe cognitive impairment with no BIMS score recorded. He required extensive assistance of two staff for personal hygiene and was care planned as totally dependent on staff for personal hygiene and oral care, with specific interventions directing staff to check nail length and trim and clean nails on bath day and as necessary. The facility’s written policy on fingernail/toenail care required daily cleaning and regular trimming to keep nails clean and prevent infection.

During an observation, the resident was seen lying in bed with a brown substance under all fingernails on his left hand, while the fingernails on his right hand were clean. A CNA, upon viewing the nails, acknowledged they needed to be cleaned and admitted she had not noticed this previously, despite stating that CNAs and nurses were responsible for checking residents’ fingernails daily and providing nail care on shower days or as needed. An LVN confirmed that CNAs were responsible for nail care for non-diabetic residents and nurses for diabetic residents, and that staff were supposed to do daily rounds to check nails for cleanliness and appropriate length. The DON stated her expectation that nail care be provided on shower days or as needed, and that she or her designee conducted routine monitoring rounds, and acknowledged that long and dirty fingernails could be an infection control issue. These observations and interviews showed that staff did not carry out the planned and policy-required nail care for this resident, resulting in unclean fingernails on his left hand.