F0677

D

Failure to Provide Required Fingernail Care for Dependent Diabetic Resident

Meridian, Idaho Survey Completed on 04-03-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide fingernail care to a resident who was dependent on staff for assistance with activities of daily living (ADLs), as required by facility policy. The facility’s Nail Care policy, implemented in December 2024 and revised in December 2025, required assessment of residents’ nails on admission and readmission, ongoing routine cleaning and inspection of nails during ADL care, and that only licensed nurses trim or file fingernails of residents with diabetes. The resident in question was admitted with multiple diagnoses including muscle wasting/atrophy and diabetes and had an ADL care plan indicating a need for partial to moderate assistance with ADLs. Despite these needs and the policy requirements, there was no documented physician order for diabetic nail care in the resident’s record.

On multiple observations over several days, the resident’s fingernails were noted to be long, thick, yellow, and dirty, and the resident stated he preferred shorter nails. Initially, the resident reported he was unaware he could ask staff to cut his fingernails, and later stated he had asked staff to cut them. An LPN, when observing the resident’s nails with the surveyor, acknowledged that the thumbnails were long, yellow, dirty, and needed to be soaked and cut, and stated that nurses perform nail care but would need to check the resident’s order to determine how often it should be done. Upon review of the record, the LPN and ADON confirmed there was no order for diabetic nail care for this resident, despite the ADON’s statement that such an order was required and should have been present from admission. This sequence of events shows that the resident did not receive nail care services in accordance with facility policy and his assessed needs.