Failure to Provide and Document Necessary Nail Care for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide basic nail care and assistance with activities of daily living for a resident who was unable to perform this care independently. The resident was admitted with multiple significant diagnoses, including sequelae of cerebral infarction, systolic heart failure, anemia, acute kidney failure, acute respiratory failure with hypoxia, osteoporosis, major muscle wasting and atrophy, muscle weakness, dysphagia, gait and mobility abnormalities, cognitive communication deficit, need for assistance with personal care, and neuromuscular bladder dysfunction. A 5-day MDS showed the resident was cognitively intact with a BIMS score of 14, had no psychosis or behaviors, but had upper extremity impairment on both sides and lower extremity impairment on one side. The care plan documented significant ADL deficits and indicated the resident required caregiver assistance with personal hygiene/oral care and extensive assistance for repositioning and turning in bed. Despite these documented needs, the EHR contained no evidence that the resident’s finger or toenail issues had been identified, nor that the nails had been trimmed or cleaned. During an observation, the resident was seen in bed with left toenails that were yellowish, brittle, and extending a few centimeters above the tip of the toes, while the right foot had an orthopedic boot and a wound dressing was present on the left foot. In a subsequent observation, the resident’s left thumb nail was jagged, and the right hand had contractures, with no indication that the toenails had been trimmed since the prior day. The resident reported that her toenails had not been cut for several months. Interviews with staff revealed inconsistencies between facility expectations and actual practice and documentation. A CNA stated that nail care is performed during showers and documented on shower sheets, and that CNA staff trim nails that are jagged or extend more than 1/4 inch, with podiatry involved for some diabetic residents’ toenails. An LVN stated that CNA staff provide fingernail care for non-diabetic residents and that nail care documentation should be in the EHR, with podiatry responsible for toenail care. Upon direct observation of the resident, both the LVN and the assigned RN acknowledged that the resident’s fingernails and toenails were excessively long and should have been clipped, and the RN stated that such issues should be identified during weekly skin checks and had not been identified by either CNA staff or nursing. Review of shower sheets and skin checks showed no documentation of excessively long nails, podiatry involvement, or nail care, despite a facility policy requiring CNA staff to trim and document nail care unless specific conditions such as diabetes, circulatory impairment, or problematic nails were present.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.