Failure to Provide Toenail Care for Cognitively Impaired Resident
Penalty
Summary
The facility failed to provide appropriate activities of daily living (ADL) care related to toenail care for one resident with severe cognitive impairment and a primary diagnosis of dementia. The resident's care plan required staff to check, trim, and clean nails on bath day and as necessary, and to report any changes to the nurse. The resident had an order for a podiatry referral to clip toenails, but there was no documentation that the resident had been seen by a podiatrist since admission. Observations revealed the resident had long, thick, discolored toenails, and the resident reported waiting several years to see a podiatrist. Interviews with facility staff indicated confusion regarding responsibility for toenail care. CNAs believed they were to notify the nurse if toenail care was needed, and the nurse would then notify social services to schedule a podiatry visit. The LPN and DON confirmed this process, but neither was aware of the resident's current toenail condition. The facility's foot care policy did not specify which department was responsible for toenail care, contributing to the lack of action. As a result, the resident did not receive necessary toenail care, and the issue was not identified or addressed by staff.