Failure to Provide Timely Foot Care Resulting in Pain and Surgical Intervention
Penalty
Summary
The facility failed to provide appropriate foot care, including timely toenail trimming, for one resident who was admitted with a history of intracerebral hemorrhagic stroke and muscle weakness. The resident repeatedly communicated to staff about discomfort and pain caused by long and ingrown toenails, which interfered with his ability to walk and wear shoes or socks. Despite these complaints, staff did not provide toenail care or arrange for timely podiatry services, and there was no documentation of nail care or cleaning being provided. The resident was not included in the list of those seen by the podiatrist during a facility visit, and staff interviews confirmed that daily nail care and regular trimming were not performed as required. The resident ultimately developed cellulitis and ingrown toenails on all toes, leading to a surgical procedure (matrixectomy) to remove all toenails. Interviews with staff, including the DON and Infection Preventionist, revealed that the facility did not attempt to arrange an earlier podiatry appointment or send the resident to an outside provider, and no documentation was provided to show such attempts were made. Facility policy required daily cleaning and regular trimming of nails, as well as documentation of care provided, but the facility was unable to produce records showing compliance with these requirements. The lack of timely and appropriate foot care resulted in the resident experiencing pain, infection, and the need for surgical intervention.