Failure to Provide Dependent Residents with Nail and Facial Hair Care
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary assistance with activities of daily living, specifically nail care and facial hair care, to dependent residents. One resident with non-Alzheimer’s dementia, moderate cognitive impairment, and dependence for bathing, dressing, and personal care had a care plan identifying a self-care deficit and the need for assistance with clean and trimmed nails. On observation, this resident’s ten fingernails were approximately half an inch long, jagged, and had brown debris underneath. The resident expressed a desire for nail care and held up her hands. The assigned nurse aide acknowledged the nails were long and stated she would provide care, but a subsequent observation days later showed the nails remained untrimmed with debris still present, and the resident again held up her hands while the assigned aide admitted nail care had not been offered that morning. Another resident with a history of stroke, severely impaired cognition, a right-hand contracture, and dependence for all ADLs had care plans and physician/psychiatry notes indicating stability, no reported refusals, and a need for assistance with bathing, dressing, and nail care on bath days. Facial hair care was not addressed in the care plan. On observation, this resident had mild body odor, long facial hair on the upper lip, chin, and lower cheeks, and long nails, including a right thumb nail about an inch long and jagged. The resident indicated wanting a shave. The assigned nurse aide reported not having offered nail care during the bath and stated she would provide nail and facial hair care, but a later observation showed the resident’s nails and facial hair unchanged. A family member visiting at the time confirmed the facial hair was the longest he had seen, described the resident as looking ragged and needing a shave, and noted dirty nails needing trimming, particularly the sharp right thumb nail, and stated he had not been informed of any refusals of care.
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