F0677

D

Failure to Provide Adequate Nail Care and Regular Bathing for Dependent Residents

New Haven, Connecticut Survey Completed on 03-19-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide adequate assistance with personal hygiene and nail care for a dependent resident with a contracted hand. Resident #2, who had Type 2 diabetes, a left hand contracture, and schizoaffective disorder, was care planned as dependent for toileting, bathing, and lower body dressing and known to sometimes refuse care. Staff interviews revealed that nail care was typically done on shower days by NAs, and multiple staff members reported ongoing difficulty accessing and cleaning the resident’s contracted left hand due to pain responses and resistance. Despite these persistent issues, nursing staff did not notify the nursing supervisor, DNS, or provider that nail care could not be adequately performed, and no alternative interventions or referrals were initiated. The DNS stated he/she was unaware of the difficulties and therefore no alternative nail care treatments were offered.

Resident #2 was later hospitalized with septic shock due to MSSA, pneumonia, UTI, and respiratory failure, and was found to have a left fourth finger paronychial infection and chronic contracture requiring nail removal and incision and drainage, with cultures growing MSSA and Staphylococcus lugdunensis. Photographs documented overgrown, unkempt fingernails on the contracted hand, and the APRN reported not being informed of nail care issues until after the hospitalization, although he/she was aware of the resident’s resistance to staff touching/opening the left hand. The APRN indicated that regular nail care could have prevented the nail infection identified during the hospitalization. Staff interviews confirmed that resistance to left hand care was longstanding, that only limited cleaning (such as sliding a thin washcloth under the fingers) was sometimes possible, and that foul odor was present after cleaning, yet this problem was not escalated as required by facility practice.

The deficiency also includes failure to provide regular bathing and nail hygiene for a cognitively impaired resident. Resident #14, diagnosed with vascular dementia and adult failure to thrive, required assistance with ADLs and was care planned to receive a shower every Monday on the 3:00 PM–11:00 PM shift. Point of Care documentation showed that this resident did not receive at least weekly showers or complete bed baths during multiple date ranges in December, January, and March, and the clinical record contained no documentation of refusals of showers or bed baths during those periods. A grievance documented that the resident was found with feces under the nails, requiring hand soaks in warm soapy water to remove, and noted that staff were educated regarding daily nail/foot care. The facility’s ADL policy required that residents unable to perform ADLs independently receive services to maintain grooming and personal hygiene and directed staff caring for cognitively impaired residents who resisted care to identify underlying causes and re-approach or use different staff, but the record did not show that such approaches were implemented for this resident during the identified periods of missed bathing care.