Failure to Provide Required Fingernail Care for Dependent Resident
Penalty
Summary
The facility failed to provide adequate fingernail care for a dependent resident who required assistance with activities of daily living, including personal hygiene. The resident was admitted with a contracture of the left hand and reduced mobility and had a care plan indicating an ADL self-care performance deficit, with dependence on staff for personal hygiene. A significant change MDS documented the resident as cognitively intact, without rejection of care, and dependent on others for personal hygiene. Bath skin review sheets for multiple dates documented only toenail condition, with no reference to fingernails. During observations on two consecutive days, the resident’s fingernails on both hands were noted to be jagged or broken, extended more than 1/4 inch past the fingertips, and had a brown substance underneath the free edge of the nails. The left hand fingers were curled inward due to contracture, though no wounds were observed in the palm when the resident uncurled the fingers using the right hand. In interviews, the resident stated a preference for short fingernails, especially on the contracted left hand, explaining that long nails often stabbed into the palm and caused discomfort. The resident reported that NAs sometimes cleaned under her nails but no one had offered to cut them, and later confirmed that although she received a bath, her fingernails were not cleaned. The NA assigned on one of the observation days acknowledged typically checking nails during baths but admitted she did not provide or offer nail care during the resident’s bed bath that morning and did not provide a reason. Nurse #1 stated that it was the assigned nurse’s responsibility to ensure nail care was provided and that nurses were supposed to complete a nail review during weekly skin assessments, but was unsure when the resident was due for such an assessment. Review of the weekly skin assessments showed no documentation regarding the resident’s fingernails on the last recorded assessment, and the DON stated she expected NAs to provide nail care on bath days and had designated an NA to complete weekly nail inspections, but was unsure how this resident’s nail care had been missed.
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