Failure to Provide Nail and Bathing Care Resulting in Infection and Poor Hygiene
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate nail care and to respond effectively to care refusals for a dependent resident with a contracted hand, resulting in an infected finger that required surgical intervention. Resident #2, who had Type 2 diabetes, a chronic left hand contracture, and schizoaffective disorder, was care planned as dependent for toileting, bathing, and lower body dressing and known to refuse care at times. Nursing assistants reported ongoing difficulty opening the resident’s contracted left hand, with the resident expressing pain, pulling away, and allowing only limited cleaning and nail trimming on some digits. Staff described being able only occasionally to slide a thin washcloth under the contracted fingers, noting a strong foul odor afterward, and reported that nail care to the left hand was an ongoing issue. Despite these persistent difficulties, nursing staff did not escalate the problem according to facility practice. One LPN stated that nail care had been an ongoing issue since the resident’s transfer to her unit prior to January 2026, that she could not adequately visualize the nails due to the contracture, and that she did not inform the nursing supervisor or provider because she believed the issue was common knowledge. The APRN reported being aware that the resident resisted staff touching or opening the left hand but was not informed of specific nail care issues until after the resident’s hospitalization for septic shock, during which a left fourth finger paronychial infection was identified and treated with nail removal and incision and drainage. Photographs from the hospitalization showed overgrown, unkempt fingernails on the contracted hand. The DNS stated he/she was unaware of any difficulties performing nail care for this resident and therefore no alternative nail care interventions were implemented. The deficiency also includes the facility’s failure to provide regular bathing and grooming care, including nail care, for a cognitively impaired resident, resulting in poor hygiene and fecal matter under the fingernails. Resident #14, who had vascular dementia with severely impaired cognition and required assistance with ADLs, was care planned to receive assistance with showering on a scheduled shift. Point of Care documentation showed multiple weeks in December, January, and March during which the resident did not receive a shower or complete bed bath at least weekly, and the clinical record contained no documentation of refusals. A grievance documented that the resident was found with feces under the nails requiring hand soaks in warm soapy water to remove. The DNS confirmed that each resident should receive at least a weekly shower or complete bed bath and that the record did not show such care in the week leading up to the grievance, despite facility policies requiring weekly bathing and routine nail care as part of standard grooming.
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