Failure to Provide Timely Podiatry Services for Toenail Care
Penalty
Summary
A deficiency was identified when a resident was observed with excessively long and jagged toenails, which had not been trimmed since their admission to the facility approximately 2.5 months prior. The resident reported that their toenails had not been cut since October 2024, and no one had offered or asked about toenail care since their arrival. The resident expressed difficulty putting on socks due to the length of their toenails. Staff interviews revealed that CNAs only cut fingernails and that toenail care is provided by an outside podiatrist who visits twice a month. However, the process for identifying residents in need of podiatry services was not effectively implemented, as the binder used to track residents requiring toenail care could not be located, and the resident's name was not on the list of those seen by the podiatrist. The Director of Nursing confirmed that toenail care is part of daily grooming and should be monitored by nursing staff during ADL care, with staff responsible for alerting nurses if toenails need attention. The resident in question had a medical history including diabetes, cerebrovascular disease, heart failure, and hemiplegia, and required supervision or assistance with personal hygiene. Despite these needs and the facility's policy requiring staff to identify residents needing toenail care, the resident had not received podiatry services, resulting in the deficiency.