Failure to Provide Nail Care for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide nail care as part of activities of daily living (ADLs) for a dependent resident. On 11/19/25 at 8:56 AM, the resident was observed lying on a low air loss mattress, awake but nonverbal, with total dependence on staff for ADLs and transfers. The resident had a tracheostomy connected to a ventilator, a gastrostomy tube connected to an enteral feeding pump, and bilateral arm contractures. During an observation with the Wound Care Coordinator and Wound Care Nurse, the resident was noted to have long, discolored fingernails on both hands with black matter under the nails. Both wound care staff stated that nail care is part of the ADL program and that CNAs are responsible for providing this care. Later that morning, the regular LPN for the resident was shown the resident’s hands with long, discolored fingernails containing black matter and stated she had not noticed this condition during her rounds, reiterating that CNAs are responsible for the resident’s nail care. The DON acknowledged that residents unable to perform ADLs independently should receive services necessary to maintain grooming and personal hygiene, and that nail care is part of ADLs, including daily cleaning and regular trimming. The resident’s comprehensive care plan documented an ADL self-care performance deficit, and the MDS quarterly assessment indicated the resident was dependent for personal hygiene. Facility policies on ADLs and nail care required maintaining personal hygiene, including self-manicure and observing and trimming nails for cleanliness, length, and condition, but these standards were not met for this resident, resulting in the observed deficiency in nail care.
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