Failure to Provide Nail Care and Timely Call Light Response
Penalty
Summary
The facility failed to provide appropriate nail care for a resident with type 2 diabetes mellitus, who was admitted with orders to be evaluated and treated by a podiatrist as needed. Despite care plan interventions to check and trim fingernails and toenails, and to notify the nurse if the resident was diabetic, the resident reported that their toenails had not been cut since admission. Staff interviews revealed confusion regarding responsibility for nail care, with aides stating they did not cut the resident's toenails due to the diabetes diagnosis, and nursing staff indicating either the podiatrist or nurse was responsible. Observations confirmed the resident's toenails were excessively long, curved, and sharp, and the resident stated they could only wear open-toed shoes as a result. There was no documentation that the resident had seen a podiatrist since admission, and the DON confirmed the toenails were too thick for staff to cut and that the resident needed podiatry care. Additionally, the facility failed to ensure timely response to a resident's call light. The resident, who had moderate cognitive impairment and was at risk for falls, was observed with their call light on for an extended period while staff were either on break or unaware of the call. The resident reported waiting 30 minutes for assistance and stated that call lights sometimes went unanswered, especially at night. Staff interviews confirmed that the resident was asked to wait until after lunch to be put in bed, and that there was a lack of awareness among staff regarding coverage during breaks. The DON and Administrator both acknowledged that call lights should be answered immediately and that staff should not ask residents to wait for assistance.