Failure to Provide Timely Foot Care and Podiatry Services
Penalty
Summary
The facility failed to assess and provide appropriate foot care for two residents, both of whom had significant medical conditions that increased their risk for foot complications. One resident had a history of cerebral infarction with hemiplegia and diabetes mellitus, was severely cognitively impaired, and was dependent on staff for all activities of daily living. The other resident had polyosteoarthritis, peripheral vascular and arterial disease, muscle weakness, and required assistance with personal hygiene. Despite these needs, neither resident received regular foot assessments to determine if nail care was needed, nor were their toenails trimmed as required. Observations revealed that both residents had long, thick toenails with crusty material underneath, and their toenails extended significantly beyond the tips of their toes. Nursing staff acknowledged that the toenails were too long and thick to be managed by nursing staff and that podiatry intervention was necessary, especially for the diabetic resident. However, neither resident was scheduled for or seen by the podiatrist during the facility's podiatry clinics, and there were no records of podiatry consultations in their medical records. Interviews with facility staff, including the DON and NP, indicated a lack of awareness regarding the residents' need for podiatry services. The DON explained that the absence of a social worker, who was responsible for scheduling podiatry appointments, may have contributed to residents not being placed on the podiatry schedule. The facility held podiatry clinics every three months, but the process for ensuring residents in need were seen was not maintained, resulting in unmet foot care needs for these residents.