Failure to Provide Nail Care as Part of ADL Assistance
Penalty
Summary
The deficiency involves the facility’s failure to provide necessary activities of daily living (ADL) care, specifically nail care, to two residents who were dependent on staff for this assistance. One resident was admitted with diagnoses including a nondisplaced fracture of the right ulna styloid process, generalized muscle weakness, and abnormalities of gait and mobility. During an observation in the resident’s room with his daughter, surveyors noted that his fingernails on both hands were long with a dark brown substance under the nail beds. The resident stated that no one had addressed his fingernails since his admission. A CNA confirmed that the resident’s fingernails were long and dirty and stated that nail care is done regularly but “it did not happen.” The second resident was admitted with hemiplegia and hemiparesis following cerebral infarction affecting the right dominant side, aphasia following cerebral infarction, and dysphagia following cerebral infarction. On three separate observations, this resident’s fingernails on both hands were repeatedly noted to be long with a dark brown substance under the nail beds, including when the resident appeared to be sleeping in bed. Multiple staff interviews confirmed that the resident’s fingernails were long and dirty. One CNA reported that the resident had received a shower the previous day and that the fingernails should have been addressed but were not. A CMA and the Unit Manager also confirmed that the resident’s fingernails remained long and dirty, and the Unit Manager stated that CNAs are expected to provide nail care on shower days and as needed, but this did not occur.
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.