Failure to Provide Appropriate Foot Care and Toenail Trimming
Penalty
Summary
A deficiency occurred when a resident with multiple medical conditions, including hemiplegia, chronic kidney disease, seizure disorder, and moderate cognitive impairment, did not receive appropriate foot care, specifically toenail trimming, after readmission to the facility. The resident required partial to moderate assistance with activities of daily living and expressed that no one had offered to trim her toenails since her readmission. Observations confirmed that her toenails were approximately 1/4 inch long, clean, thin, and in need of trimming, but she did not report pain. The resident's care plan addressed assistance with personal hygiene and oral care but did not specifically mention toenail trimming. There was no physician's order or referral to a podiatrist for foot care. Interviews with staff revealed inconsistent understanding of responsibilities regarding toenail care, with some staff indicating it was the responsibility of CNAs for non-diabetic residents and others stating it was the nurse's responsibility. Staff also described procedures for referring residents to podiatry, particularly for those with diabetes or thick toenails, but these procedures were not followed for this resident. The facility's foot care policy emphasized daily assessment and care of feet, with podiatrist involvement if required for toenail trimming. Despite this, the resident was not placed on the podiatry list, and no referral was made. Multiple staff interviews confirmed that the resident's toenails remained untrimmed, and the lack of action was attributed to unclear delegation and failure to follow established protocols for foot care and podiatry referral.