Failure to provide ordered ADL and hygiene care for a resident with severe cognitive impairment, hemiplegia, and COPD. The resident was observed with long jagged fingernails with black debris, flaking skin on a long beard, strong body odor, and strong oral odor while receiving PEG tube feeding. Active orders required mouth care and teeth brushing every shift and weekly nail care, and staff described a bathing and nail care schedule that did not match the observed condition.
Failure to Provide Needed Nail Care: The facility failed to provide required nail care for two residents who needed assistance with ADLs. One resident with DM had fingernails observed to be very long with dark debris underneath despite a weekly diabetic nail care order on the TAR, and another resident with DM and ESRD had excessively long, thick, curved toenails after reporting he had been asking staff for care without success. The DON and RN confirmed the nail care concerns and that staff had not ensured the needed care was completed.
Failure to provide ADL nail care. A resident with an order for diabetic nail care had fingernails observed to be about one inch long with jagged edges and dark debris underneath. The resident said the RN usually trims them every couple of weeks and agreed they needed trimming. The DON confirmed the nails needed to be trimmed and stated diabetic nail care should be completed weekly by the RN; the resident was cognitively intact with a BIMS score of 15.
A resident with moderate cognitive impairment and a right wrist fracture did not receive needed ADL assistance to maintain hygiene and grooming. The resident’s fingernails were observed to be about one inch long with a brown substance underneath them despite an order for monthly and/or PRN nail trimming, and the resident said she did not prefer long nails. The resident was also observed wearing the same clothing on consecutive days and stated no one had changed her clothes since the day before. A CNA confirmed the nails were long and that clothing should be changed daily, and the DON confirmed the nails had been observed on admission but not addressed.
A facility failed to maintain residents’ personal hygiene by not cleaning and trimming one resident’s fingernails and not removing unwanted facial hair for two residents. One resident with Alzheimer’s disease and a need for personal care had jagged, dirty fingernails that remained unchanged, while two other residents were observed with facial hair on the chin and mouth area and stated they wanted it shaved off. Staff interviews confirmed the grooming needs were not being met, and an LPN and the DON stated residents should be kept clean and presentable.
Failure to provide shaving assistance during ADL care affected two residents who were unable to manage grooming independently. One resident with COPD and intact cognition was observed with chin hair after a shower, and staff confirmed the CNA should have shaved her during bathing. Another resident with COPD and moderate cognitive impairment was observed with long facial hair while receiving bed baths, and staff confirmed he should have been shaved on his scheduled bath day.
Two residents who depended on staff for personal hygiene were left with unwanted facial hair despite facility policy stating grooming includes shaving and removal of facial hair. Staff confirmed CNAs were responsible for addressing facial hair during shower time, and both residents were observed with chin hairs; one resident with severe cognitive impairment said she wanted them shaved, and the other said the hair bothered her and made her feel like an odd ball.
Failure to provide ADL assistance with grooming and shaving affected two residents. One resident with severe cognitive impairment and dependent personal hygiene needs had facial hair left on her chin despite documentation and staff acknowledgment that it should be removed on shower days, and the resident and her RR stated she did not want facial hair. Another cognitively intact resident with hemiplegia was observed dry shaving himself with a razor and no staff assistance, even though staff stated residents were not permitted to shave themselves and shaving was to be completed by staff.
Failure to maintain fingernail hygiene for two residents was observed when their fingernails were found long and jagged, with staff confirming the nails should be kept clean and trimmed as needed. One resident had severe cognitive impairment and diagnoses including dementia, anxiety, and need for assistance with personal care, while the other had moderate cognitive impairment and hypertensive heart disease. Staff stated long, jagged nails can cause skin tears and infection, and the DON said CNAs trim nails on shower days unless the resident is diabetic, in which case RNs do so.
Failure to provide ADL grooming and oral care: surveyors observed one resident with long facial hair, another with long jagged fingernails, and a third with long jagged fingernails plus poor oral hygiene with blackened, deteriorated teeth and buildup along the gum line. An LPN, CNA, and DON confirmed the conditions, and records showed the residents had significant medical and cognitive impairments, including cerebral infarction, severe protein-calorie malnutrition, MS, hemiplegia, metabolic encephalopathy, and BIMS scores indicating moderate impairment.
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