Failure to Provide Appropriate Foot Care and Podiatry Referral
Penalty
Summary
The facility failed to provide appropriate foot care and follow its own policies and procedures for a resident who exhibited significant foot and toenail issues. Observations revealed that the resident had dry, flaky skin on both feet, red and swollen toes, long, thick, discolored, and brittle toenails, as well as wounds and blackish debris between the toes. Despite these visible issues, there was no evidence that foot care was provided or that a referral to a podiatrist was completed, even though a physician's order for a podiatry consult was present upon admission. Interviews with nursing staff confirmed that the resident's toenails were overgrown, thick, and discolored, with possible fungal involvement, and that the resident had wounds and very dry skin. Staff acknowledged the need for a podiatry referral but admitted that no action was taken to initiate the referral or provide necessary foot care. Additionally, a CNA reported that while attempting to clean the resident's feet, the resident complained of pain, and the cleaning was not completed. No further attempts were made to address the resident's foot hygiene. Record reviews showed that nursing assessments and weekly summaries did not document the condition of the resident's skin, toes, or toenails, and there was no follow-up or progress notes from social services regarding the need for podiatry or foot care. The facility's policies required referral to qualified professionals for foot disorders and regular documentation and follow-up by social services, but these procedures were not followed, resulting in the resident's ongoing foot issues.