Failure to Provide Physician-Ordered Foot Care
Penalty
Summary
A resident with diagnoses including peripheral vascular disease, neuropathy, and diabetes mellitus was not provided with foot care and treatment as ordered by the physician. The resident had a physician's order for podiatry visits every two months and as needed for fungal and hypertrophic nails, corns, and calluses. Despite this, the resident reported having long, thick toenails and a fungal condition, and had not seen the podiatrist for several months. Observation confirmed the resident had long, thick toenails and dry, cracked feet. The last documented podiatry visit was several months prior to the observation. Interviews with CNAs revealed that they were not permitted to cut or file toenails and were instructed to report long toenails to a nurse. The Assistant Director of Nursing confirmed that the process required the nurse to notify the social worker to add the resident to the podiatry list. However, the social worker was unaware of the resident's specific order for podiatry every two months and had not included the resident on the rolling schedule for podiatry visits. The facility's policy required referral to qualified professionals for residents with foot disorders or related medical conditions, but this was not followed for the resident in question.