Failure to Provide and Document Required Foot Care for Resident with PVD
Penalty
Summary
The facility failed to follow its nail care policy by not observing or documenting the condition of a resident's toenails during weekly skin assessments and bathing. Despite the resident's care plan specifying daily foot inspections and reporting of changes, there was no documentation of toenail overgrowth or fungal presence in the resident's records from January to April. Shower sheets and weekly nursing skin assessments lacked any mention of the toenail condition, and some assessments were not documented at all. The resident involved had multiple diagnoses, including Peripheral Vascular Disease, Alzheimer's Disease, hypertension, and chronic kidney disease, and was at risk for skin integrity issues. The resident's toenails became overgrown, thickened, yellow, and developed onychomycosis, with associated pain and subungual debris. The podiatrist had not seen the resident for nine months, despite the facility's process for scheduling podiatry visits and the resident's risk factors requiring regular foot care. The omission was only identified after a family grievance prompted an emergency podiatry visit. Interviews with staff revealed that the resident was not included on the podiatrist's list due to an oversight, and there was no documentation of communication with the family regarding concerns about foot care. The facility's own assessment and nail care policy required observation and documentation of nail conditions, especially for residents with PVD, but these procedures were not followed, resulting in the resident developing significant toenail and foot issues.