Failure to Provide Required Nail and Personal Hygiene Care
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate nail care and personal hygiene assistance to a resident who required staff support with activities of daily living. The resident was admitted with recent partial amputation of two fingers, end stage renal disease, Type 2 diabetes mellitus, and a history of cerebrovascular accident. The admission MDS documented that the resident was cognitively intact, required substantial assistance for toileting hygiene, and needed set up/clean up assistance with personal hygiene. The care plan identified an ADL self-care deficit and included interventions to check nails to ensure they were clean and neat in appearance and to provide showers per schedule. Despite this, repeated observations over several days showed the nails on the resident’s left hand extended approximately a quarter inch beyond the fingertips with thick black matter under each nail. Record review showed the resident was scheduled for baths twice weekly on the night shift, but there were no shower or personal hygiene sheets for the resident from November through February. Night-shift NAs assigned on the resident’s bath days stated they relied on the posted bath schedule and a Bath Check List to document completion of care and to note nail care needs, but they reported they had not noticed the condition of the resident’s fingernails. Another NA who provided a bed bath reported no personal care issues and did not recall long or dirty nails. The nurse assigned to the resident was unaware of any nail care needs, stated no NA had reported concerns, and had not observed the nails. The Unit Manager and DON both stated that nail care was expected to be completed with scheduled baths and that NAs should notify nurses, especially for residents with diabetes, but they had not assessed this resident’s nails and did not know why no bath sheets existed for the resident. The Administrator stated it was unacceptable for residents to have dirty fingernails and that nursing staff were responsible for ensuring neat and clean nails.
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