Failure to Provide Necessary Foot Care and Timely Assessment
Penalty
Summary
A deficiency occurred when a resident who required assistance with foot care did not receive necessary interventions to maintain skin integrity and prevent complications. The resident reported that her toenails were excessively long and thick, and that she was not seen by the podiatrist during the most recent visit. She also complained of left heel pain, which upon observation, revealed a circular area with thick, dry, peeling skin, dark redness, and a small open wound with dark purple edges. The resident stated she had been self-applying lotion, but staff were not providing any treatment. Multiple calluses and overgrown toenails were observed on both feet. Review of the resident's records showed no documentation of skin concerns, no treatment orders for the left heel, and repeated skin checks that failed to identify any issues. Interviews with facility staff, including the wound care nurse, ADON, and an LPN, confirmed that the resident's foot issues were not identified or documented during routine skin checks and audits. The wound care nurse was unaware of the wound and acknowledged that the resident's foot concerns should have been discovered earlier. The LPN admitted to not accurately documenting the resident's skin condition and had no record of applying lotion, despite doing so. The DON confirmed the resident had excessively long toenails and had not been seen by the podiatrist since February, placing the resident at risk for further complications. The resident was cognitively intact and had a history of callosities and other medical diagnoses.