Failure to Provide Ordered Diabetic Nail Care for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide ordered nail care as part of activities of daily living (ADL) for a dependent resident with diabetes and bilateral hand contractures. The resident had a physician’s order for daily nail cleaning and weekly trimming on the 7:00 AM to 7:00 PM shift as part of diabetic care, and the March Medication Administration Record (MAR) indicated that diabetic care, including fingernail cleaning and trimming as needed, should be completed daily. The resident’s quarterly MDS and care plan documented that the resident had intact cognition, limited range of motion in both hands, used hand guards, required dependent care for hygiene and nail care, and had no rejection of care. Despite this, surveyor observations on multiple days showed the resident’s fingernails on both hands were long and dirty, with brown matter under the thumbs and whitish substance under other fingers, and the resident reported it had been a long time since staff cleaned or cut his nails and that nail care was not offered. Staff interviews and record reviews further demonstrated that the ordered nail care was not being provided. Nursing assistants on both day and night shifts reported assumptions that the other shift had bathed the resident and did not perform or ensure nail care, with one aide acknowledging she had not noticed the nails needed cleaning and another stating she did not bathe the resident on consecutive days because she believed night shift had done so. A night-shift aide stated she bathed the resident but did not clean or trim the nails due to the resident’s contracted hands and did not report the nail condition to nursing. The nurse assigned to the resident acknowledged the physician’s order for daily cleaning and weekly trimming, agreed the nails needed care, and had not assessed the nails that morning; the MAR for that day was not initialed for diabetic nail care. Throughout these observations and interviews, there was no indication that the resident refused care, yet the resident’s nails remained long and dirty over several days.
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