DECATUR, GA - State inspectors found significant deficiencies in basic care services at East Lake Arbor nursing home during a January 2025 inspection, documenting failures to provide essential daily care including bathing, nail care, and prescribed therapeutic treatments for vulnerable residents.
Personal Hygiene Care Failures Put Residents at Risk
The Georgia Department of Health inspection revealed that three residents experienced prolonged periods without adequate personal hygiene care, violating federal standards that require nursing homes to assist residents who cannot perform activities of daily living independently.
Diabetic Resident's Painful Nail Neglect
Inspectors documented a particularly concerning case involving a diabetic resident with stroke-related paralysis on his right side. During multiple observations over two days, surveyors found the resident's fingernails severely overgrown, dirty, and causing him physical pain. The resident's contracted right hand showed fingernails that had grown so long they were "digging into the skin."
When questioned by nursing staff during the inspection, the resident confirmed his discomfort, stating "Yes, it's hurting me really bad" when asked if he wanted his nails clipped. The facility's Director of Nursing acknowledged that overgrown nails posed health risks, particularly noting that "a buildup of dirt could be a health risk."
For diabetic patients, proper nail care represents a critical safety issue. Diabetes can reduce blood circulation and sensation in extremities, making seemingly minor injuries potentially serious. Overgrown nails that dig into skin can create open wounds that heal poorly in diabetic patients and may lead to infections. The resident's stroke-related paralysis on his right side made self-care impossible, requiring staff intervention that did not occur.
Second Resident Also Lacked Nail Care
A second resident with Parkinson's disease and diabetes also experienced neglected nail care. Inspectors observed the resident with "long, unclipped" nails containing "dirt and debris built up on the thumb." Despite the resident's contracted hands making self-care impossible, staff had not provided adequate nail maintenance.
When asked directly, this resident also confirmed he wanted his nails clipped, responding "Yes" when questioned whether his nails bothered him. However, staff members gave conflicting explanations about responsibility for this care, with some claiming the resident typically refused nail care while others indicated hospice services were responsible.
Critical Bathing Schedule Deficiencies
The inspection also revealed systematic failures in maintaining basic bathing schedules. One resident with stroke-related paralysis and dementia was scheduled for showers three times per week but consistently missed these essential hygiene services.
Documentation showed this resident received only 14 showers over a four-month period from October 2024 through January 2025, far below the scheduled 36 showers. The resident told inspectors he "did not get his shower last Saturday" and could not recall receiving recent baths, indicating the missed care was noticeable to him.
During observations, inspectors noted the resident's skin appeared "dry and ashen" with "debris noted on his pillow and bedsheets," suggesting inadequate personal hygiene maintenance. For residents with limited mobility and cognitive impairment, regular bathing prevents skin breakdown, maintains dignity, and reduces infection risk.
Therapeutic Treatment Abandonment
Perhaps most concerning was the complete discontinuation of prescribed therapeutic treatments for a stroke patient. The resident had physician orders for splints to prevent contractures and maintain range of motion in his paralyzed right hand and knee. Physical therapy had recommended a "Restorative Splint and Brace Program" with passive range of motion exercises and daily splint application for four to six hours.
However, inspectors found no evidence these prescribed treatments were being provided. During multiple observations over three days, the resident was never wearing his prescribed splints. When interviewed, the resident expressed desire for help, stating he "would feel more comfortable if they could put something in his hands, and maybe it wouldn't hurt him so much."
The resident told inspectors he "never refused to get any help for his hand, and if possible, he would love to get some help now." Despite this willingness to participate, staff could provide no documentation of restorative services for the previous six months.
Medical Consequences of Care Failures
These violations represent more than cleanliness issues - they constitute medical neglect with serious health implications. Proper nail care prevents infections, particularly crucial for diabetic patients who face elevated infection risks and slower healing. For stroke patients, prescribed splints prevent permanent contractures that can cause pain and further limit function.
Regular bathing maintains skin integrity, prevents infections, and preserves dignity. For residents with limited mobility, missed baths can lead to skin breakdown, urinary tract infections, and other complications. The psychological impact of poor hygiene also affects mental health and social interaction.
Staffing and System Failures
The violations suggest systematic breakdowns in care delivery and documentation. Staff members provided inconsistent explanations about care responsibilities, indicating confusion about protocols. The facility's Director of Nursing cited "system acquisition issues" when unable to produce documentation of restorative care.
Federal regulations require nursing homes to ensure residents receive necessary assistance with activities of daily living. The facility's own policies stated residents "who are unable to carry out activities of daily living will receive the necessary services to maintain good nutrition, grooming, and personal and oral hygiene."
Additional Issues Identified
Beyond the major personal care failures, the inspection revealed other concerns:
- Inadequate documentation systems for tracking completed care - Staff confusion about responsibilities for different aspects of resident care - Insufficient oversight of missed scheduled services - Poor communication between different care providers
The violations affected residents with complex medical conditions including diabetes, stroke, Parkinson's disease, and dementia - populations requiring careful attention to prevent complications from seemingly basic care lapses.
The facility received citations for failing to provide activities of daily living assistance and failing to maintain range of motion and mobility services. These represent fundamental obligations nursing homes must meet to ensure resident safety and dignity.
State regulations require nursing homes to develop corrective action plans addressing identified deficiencies. The citations underscore the importance of consistent, documented care delivery for vulnerable populations dependent on facility staff for basic human needs.
Full Inspection Report
The details above represent a summary of key findings. View the complete inspection report for East Lake Arbor from 2025-01-09 including all violations, facility responses, and corrective action plans.
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