Failure to Provide Adequate Foot Care Due to Unaddressed Care Refusal
Penalty
Summary
The facility failed to provide appropriate foot care for a resident with multiple medical conditions, including dementia, diabetes mellitus, muscle weakness, and difficulty walking. The resident's toenails were observed to be long, thick, discolored, and curving toward another toe, with staff and podiatrist documentation confirming the inability to trim the nails due to the resident's combative and resistive behaviors. Despite care plan interventions to refer to a podiatrist and monitor foot care needs, there were no documented further attempts to address the toenail issue after an initial refusal, and the resident's condition persisted over several months. Staff interviews revealed that the resident was known to be combative and would not allow staff to provide personal care, including nail trimming, often requiring multiple staff members for basic hygiene tasks. The CNA and LVN both acknowledged the resident's refusal and the risk posed by the untrimmed nails, but also indicated that alternative approaches or interventions, such as medication to facilitate care, had not been attempted. The podiatrist confirmed multiple unsuccessful attempts to provide care, and the responsible family member was aware of the ongoing issue and the need for podiatric intervention. Facility leadership, including the DON and Administrator, were aware of the resident's right to refuse care but had not implemented additional strategies to address the ongoing refusal or to mitigate the risk associated with the resident's foot condition. The facility's policy required staff to attempt to identify underlying causes of care refusal and to try different approaches, but there was no evidence that such measures were consistently or effectively implemented in this case.