Failure to Develop and Implement Comprehensive Care Plan for ADL Nail Care and Prosthesis Management
Penalty
Summary
The deficiency involves the facility’s failure to develop and implement a comprehensive, person-centered care plan that addressed all of a resident’s needs, specifically Activities of Daily Living (ADL) nail care for a resident with diabetes and prosthesis/shrinker sock care for a resident with bilateral below-knee amputations. The facility’s policy required a comprehensive care plan with measurable objectives and timetables to meet each resident’s physical, psychosocial, and functional needs. The discharge Minimum Data Set for Resident 1 showed the resident required substantial/maximal assistance with personal hygiene and had a diagnosis of diabetes, yet the comprehensive care plan printed in February 2026 contained no care plan for providing fingernail care appropriate for a resident with diabetes. Surveyor observations on multiple dates showed Resident 1 with long fingernails and brown material underneath the fingernails on both hands, including after the resident reported having had a shower the previous day. The resident stated that it was “hit or miss” whether their fingernails were trimmed. Staff D, a CNA, stated that nail care was included in ADLs for dependent residents and that nurses provided nail care for residents with diabetes, with CNAs responsible for notifying nurses when nails were long or dirty. Staff D also stated that Resident 1 needed total care for personal hygiene and that CNAs determined needed ADL care by checking the Kardex. Joint observations with Staff D and Staff C confirmed that Resident 1’s fingernails were long, dirty, and had brown/black material underneath, and joint record review with Staff C confirmed there was no care plan for providing fingernail care for this resident. The deficiency also included failure to implement the existing care plan for prosthesis and shrinker sock use. Resident 1’s comprehensive care plan and Kardex documented bilateral below-knee amputations and directed that the prostheses be on daily in the morning until bedtime, with shrinker socks on when the prostheses were off. During observation, Resident 1 was in bed with the prostheses off and without shrinker socks, and the resident stated the shrinker socks were supposed to be changed every day. Staff D confirmed via the Kardex that shrinker socks should be on when the prostheses were off, found the shrinker socks in the nightstand, and then applied them, stating they should have been on. Staff C, the RCM, and the DON each stated in interviews that they expected staff to follow care plans, that a licensed nurse should trim the nails of a resident with diabetes, and that shrinker socks should be on when the prostheses were off, confirming that the documented care plan interventions for prosthesis and shrinker sock use were not being consistently implemented.
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