Failure to Provide Timely and Appropriate Foot Care Resulting in Harm
Penalty
Summary
A deficiency occurred when the facility failed to provide necessary foot care and treatment for a resident with multiple comorbidities, including diabetes, cerebrovascular accident, and chronic ischemic heart disease. The resident's care plan required daily foot care, regular nail trimming, and prompt reporting of any changes in foot condition. Despite these requirements, the resident developed significant foot complications, including overgrown toenails, bleeding, and infection, which were not adequately addressed by facility staff. The resident was transported to the emergency room by a family member after exhibiting signs of foot injury and infection, including a bleeding toenail and overgrown nails. Medical records indicated delays in obtaining and sending cultures, as well as delays in initiating podiatry consultation and treatment. The resident's condition progressed to a cutaneous abscess, MRSA infection, and repeated fevers, with documentation showing ongoing pain and infection in the left great toe. Despite repeated requests from the family and documentation of the need for podiatry evaluation, the resident was not seen by a podiatrist during the admission, and there was confusion among staff regarding scheduling and follow-up for podiatry services. Ultimately, the resident's condition deteriorated, resulting in sepsis, gangrene, osteomyelitis, and a pressure ulcer of the left great toe, necessitating surgical amputation. Interviews with family and facility staff revealed lapses in communication, scheduling, and follow-up for podiatry care, as well as a lack of documentation regarding resident refusals or timely professional assessment. The facility also experienced a period without podiatry coverage, further contributing to the lack of appropriate foot care and timely intervention.