F0677

D

Failure to Provide Adequate Hand and Nail Hygiene Assistance for Two Residents

Stockton, California Survey Completed on 02-11-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide adequate assistance with activities of daily living (ADLs), specifically hand and fingernail hygiene, for two residents who required help with personal care. One resident’s MDS dated 1/26/26 showed that he was cognitively able to make reasonable decisions but needed substantial/maximal assistance with personal hygiene and mobility and was totally dependent on staff for bathing or showering. During observation in his room, this resident was found lying in bed with fingernails approximately one-quarter inch long and a brown substance accumulated under them. He stated he did not like his nails that long, confirmed there was dirt embedded under them, and reported that he had asked staff to cut his nails for a few weeks without the request being fulfilled. He also stated he felt gross eating with dirty fingernails.

Later the same day, when a CNA brought this resident his lunch tray, the resident again asked for his nails to be cut. The CNA confirmed that his nails were very long and dirty with a brownish substance under them and stated that CNAs were not allowed to cut residents’ fingernails, explaining that nails could be brushed clean during bathing but not trimmed by CNAs. The resident’s care plan for skin inflammation indicated goals for his skin to remain intact, clean, and dry with reduced irritation and included education to avoid scratching, but there was no indication that his ongoing requests for nail care had been addressed. The DON later confirmed that this resident’s nails appeared not to have been trimmed for several weeks or months and that the long, dirty nails did not meet her expectations for hygiene.

The second resident’s MDS indicated he was cognitively intact with a perfect BIMS score and required substantial/maximal assistance with showering/bathing and supervision or touching assistance for personal hygiene. During observation in his room, he was noted to have visible brown dirt stuck in the creases and backs of his hands, and long, dirty fingernails extending past the fingertips with brown and black substance caked underneath. He stated he had told CNAs he wanted his fingernails trimmed but was told staff were not allowed to cut his nails, and that his hands and nails were dirty because he could not get staff to help him. Later, when a CNA assisted him with lunch tray setup, the CNA confirmed his hands were dirty and his nails were long with dirt caked under them but did not offer assistance with hand hygiene or nail trimming, stating she had previously encouraged him to clean his hands before meals and that he often refused, so she did not ask.

The facility’s own staff and records reflected expectations and orders for nail and hand care that were not carried out for this resident. The CNA stated that facility procedure was to encourage and assist residents with hand hygiene before meals and, if they refused, to involve the nurse and document refusals. The LN stated CNAs were supposed to help residents wash hands before meals and that nail care was to be provided to all residents every Sunday by any CNA or LN. The second resident’s record contained an order allowing nail cutting once every four weeks on Sunday, and his care plans addressed risk for skin issues and self-care deficit, including improving hygiene status and assuring tasks were done to facility standards. The DON confirmed that both residents should have had nails trimmed weekly on Sunday or as needed, that staff did not need an order to trim fingernails unless specified by the physician, and that she expected all residents’ hands to be cleaned before meals with refusals and education documented. Review of the second resident’s record showed only two documented refusals of bathing and no documentation of refusals or education related to hand hygiene or nail care, despite his observed condition and his statements that he could not get staff to help him with his hands and nails.

The facility’s policies on ADLs and nail care required that residents unable to carry out ADLs independently receive services necessary to maintain grooming and personal hygiene, including appropriate support and assistance with hygiene and dining, and that staff attempt to identify causes of resistance or refusal and approach residents differently or involve another staff member. The nail care policy required safe, hygienic, and thorough nail care assistance and consultation with an RN for special directions, with documentation of any nail care provided. Observations, interviews, and record review showed that these policies and expectations were not followed for the two residents, resulting in long, dirty fingernails with brown or black substance embedded under them and failure to assist one resident with hand hygiene before a meal.