Failure to Provide Adequate Nail Care and Shaving for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate assistance with activities of daily living (ADLs), specifically nail care and shaving, for one cognitively intact resident who required substantial/maximal assistance with personal hygiene. The resident had multiple medical diagnoses, including hemiplegia, gait abnormalities, muscle weakness, and a history of falls, and was care planned as having a self-care deficit requiring assistance with all ADLs. The facility’s own A.M. care policy required cleaning under fingernails and maintaining nails at a smooth, safe length, and the resident rights policy affirmed the right to a dignified existence and accommodation of individual needs. Documentation and staff interviews showed that the resident’s toenails and fingernails were not maintained appropriately over time. CNA skin/shower worksheets on multiple dates documented long toenails and nail bed issues, and a foot and ankle clinic note later described elongated, dystrophic toenails with subungual debris and pain on palpation, with onychomycosis affecting all toenails. CNAs reported that the resident’s toenails were long and causing aching, and that podiatry services were dependent on being placed on a list. One CNA stated that when the resident returned from the hospital, the fingernails were beyond the skin with a lot of black dried material under them, which the resident identified as stool, and that the resident repeatedly requested fingernail clipping. The resident also did not receive consistent shaving and facial hair care despite requesting it. The resident reported it had probably been two months since staff had shaved him, despite asking aides to do so, and was observed with a long, unshaven beard and mustache. Staff interviews confirmed that the resident’s facial hair was long, thick, grizzly, and not well maintained, and that clippers were broken and disposable razors were reported as ineffective. A hospital social worker and a physical therapist raised concerns about the resident’s hygiene, including long facial hair, fingernails, and poor foot condition. During an observation, the fitted sheet under the resident was yellowish and unclean with multiple small dark particles, and a CNA acknowledged it did not appear to have been changed and that it had been a while since the resident had been out of bed. These observations and statements demonstrate that the facility did not consistently provide the personal hygiene assistance required by the resident’s condition and care plan.
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