Failure to Provide Required Nail and Personal Hygiene Care for Dependent Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate ADL care, specifically personal hygiene and nail care, to a dependent resident in accordance with facility policy. The facility’s "Personal Care Procedure" policy, last reviewed on January 23, 2026, required staff to provide needed assistance with bathing, showers, oral care, grooming, and nail care, including cleaning and trimming nails as needed during showers, and to document care or refusals. The resident involved was admitted with chronic atrial fibrillation and dementia and had an MDS dated February 11, 2026, indicating severe cognitive impairment (BIMS score of 3) and total dependence on staff for bathing and personal hygiene. The resident’s Kardex specified scheduled showers on Wednesday and Saturday evenings and a preference for showers over bed baths or baths. Facility documentation (Documentation Survey Report v2) for March and April 2026 showed that showers were recorded as completed as scheduled, including a shower documented the evening before the surveyor’s observation. However, during an observation at midday the following day, the resident was noted to have visible buildup and grime under all fingernails on both hands, with debris and grayish-black residue under the nail tips. The facility could not provide documentation that the resident had refused nail care or that fingernail cleaning had been performed as required by policy, despite the documented shower the previous day. When these findings were reviewed with the DON, the facility was unable to produce evidence that staff followed the facility’s personal care policy to ensure appropriate hygiene for the resident.
Plan Of Correction
Facility cannot retroactively correct deficiency as it relates to 51 on 4/6/2026 regarding ADL care. 2. Facility residents were reviewed by nursing and provided nail care on 4/13/26 and 4/14/26. 3. Facility personnel care procedures reviewed and updated. Education provided to facility nursing staff on the facility Personnel Care Procedure of nail care completion after showers and as needed during ADLs. 4. LPN charge nurse to complete random nail audits daily X 2 weeks, then weekly X 2 months with results sent to the QA committee to ensure compliance with resident grooming and personnel hygiene. 5. April 25, 2026
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