Health inspection·August 16, 2023

F 0677 Provide care and assistance to perform activities of daily living for any resident who is unable. Level of Harm - Minimal harm or potential for actual harm **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on observation, interview, and record review the facility failed to provide the necessary services for residents who are unable to carry out activities of daily living to maintain good grooming and personal hygiene for 1 (Resident #1) of 6 residents reviewed for ADLs. Residents Affected - Few The facility failed to ensure Resident #1 had his fingernails cleaned and trimmed. This failure could place residents who were dependent on staff for ADL care at risk for loss of dignity, risk for infections and a decreased quality of life. Findings include: A record review of Resident #1's Quarterly MDS assessment dated [DATE] reflected Resident #1 was an [AGE] year-old female admitted to the facility on [DATE] with diagnoses included dementia, type 2 diabetes mellitus, muscle weakness, and lack of coordination. Resident #1 had a BIMS of 03 which indicated Resident #1's cognition was severely impaired. She required extensive assistance of two-person physical assistance with personal hygiene. A record review of Resident #1's Comprehensive Care Plan, dated 08/16/23, reflected the following: problem: ADL function are impaired related to gait imbalance/lack of coordination, history of bilateral shoulder pain, cognitive deficits. Goal: will maintain a sense of dignity by being clean, dry, odor free, and well-groomed over next 90 days. Interventions: assist with all ADL's as needed. An observation on 08/16/23 at 12:34 PM revealed Resident #1 was laying in her bed. The nails on both hands were approximately 0.3 centimeter in length extending from the tip of her fingers. The nails were discolored tan and the underside had dark brown colored residue. Resident #1 unable to answer questions. Interview on 08/16/23 at 12:52 PM, CNA A stated CNAs were allowed to cut the residents' nails if they were not diabetic. CNA A stated she would talk to the nurse about Resident #1's long nails because she was diabetic. Interview on 08/16/23 at 12:59 PM, LVN B stated CNAs were responsible to clean and trim residents' nails as needed. LVN B stated only nurses cut residents' nails if they were diabetic. LVN B stated no one notified him Resident #1's nails were long and dirty, and he had not noticed the nails himself. LVN B stated Resident#1 was diabetic he would clean and trim his nails. Interview on 8/16/23 at 2:33 PM, the DON stated nail care should be completed as needed and every Page 1 of 2 676128 676128 08/16/2023 The Madison on Marsh 2245 Marsh LN Carrollton, TX 75006

F 0677 Level of Harm - Minimal harm or potential for actual harm time aides wash the residents' hands. The DON stated nails should be observed daily. The DON stated nurses were responsible for trimming the nails of residents who were diabetic, and CNAs could trim other residents' nails. The DON stated she expected CNAs to offer to cut and clean nails if they were long and dirty. The DON stated residents having long and dirty nails could be an infection control issue. Residents Affected - Few 08/16/23 at 2:33 PM the surveyor requested the nail care policy. Not provided. 676128 Page 2 of 2