Failure to Provide Adequate Nail and Personal Hygiene Care for Dependent Diabetic Resident
Penalty
Summary
The facility failed to provide necessary assistance with activities of daily living, specifically personal hygiene and nail care, for one resident who required substantial to maximal assistance. Facility policy on ADLs stated that appropriate care and services, including hygiene such as bathing, dressing, grooming, and oral care, were to be provided in accordance with the care plan. The resident’s discharge Minimum Data Set indicated a need for substantial/maximal assistance with personal hygiene and documented a diagnosis of diabetes. The resident’s ADL care plan required at least one staff member to assist with personal hygiene. Despite this, observations on multiple days showed the resident with long fingernails and brown material underneath the fingernails on both hands, and the resident reported that nail trimming was inconsistent. Staff interviews and record reviews showed inconsistent practices and missing orders related to nail care for this resident. A CNA stated that nail care was part of ADLs and that nurses were responsible for nail care for residents with diabetes, while CNAs were expected to notify nurses if nails were long or dirty; the CNA also stated that the resident needed total care for personal hygiene and confirmed the nails were long and dirty. An LPN stated that nurses provided nail care for residents with diabetes and that anyone could clean under the nails, but indicated there should be a physician order for nail care; record review showed no such order for this resident. The Resident Care Manager similarly stated that aides could clean fingernails and nurses should trim nails for residents with diabetes, and expected a physician order documented in the MAR, which was not present. The DON stated that staff were expected to provide ADLs, including nail care, for dependent residents, that nurses should provide nail care for residents with diabetes, and that they would not expect a resident’s fingernails to be long and dirty after a shower. These observations and statements demonstrated that the resident’s personal hygiene needs, specifically nail care, were not met in accordance with policy and the care plan.
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