Failure to Provide Required Fingernail Care as Part of ADL Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide fingernail care as part of activities of daily living (ADLs) for one resident who was dependent on staff for personal hygiene. Surveyors observed the resident seated in a wheelchair near the south unit nurse’s station with several fingernails on both hands jagged and extending approximately 1/2 inch beyond the nail bed, with photographic evidence obtained. When asked, the resident stated he did not like his nails so long but could not remember if he had asked staff to trim them. Record review showed the resident had COPD, type II diabetes mellitus without complications, pseudobulbar affect, stage 2 chronic kidney disease, and dementia, with a BIMS score of 7/15 indicating severe cognitive impairment. The MDS and care plan documented that the resident required extensive to dependent assistance with ADLs and was to be kept clean and well-groomed, with staff assisting with hygiene, including bathing and grooming. Staff interviews confirmed that the resident’s fingernails were excessively long and should have been trimmed. A CNA stated that fingernails are usually trimmed on shower days when nails are softer, and an LPN who administered medications to the resident that morning acknowledged the nails were much too long but had not noticed them earlier. A unit manager and the ADON explained that CNAs and nurses are permitted to trim or file fingernails, and that for diabetic residents a nurse must trim the nails. The ADON described a process in which CNAs document shower assistance on shower sheets and indicate when fingernails need attention by circling a body diagram; however, a review of the resident’s shower sheets showed no documentation that fingernail care was needed. The facility’s ADL policy stated that residents unable to carry out ADLs independently are to receive services necessary to maintain grooming and personal hygiene, including hygiene such as bathing, dressing, grooming, and oral care, but this was not carried out for this resident’s fingernail care.
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