Failure to Provide Foot Care and Document Refusals
Penalty
Summary
Facility staff failed to provide appropriate foot care for one resident, resulting in long, untrimmed toenails that were observed to be uneven and approximately 1/8 inch from the nailbed. The resident, who was assessed as severely impaired in decision-making and required substantial to maximal assistance with personal hygiene and bathing, was seen walking barefoot in the hallway. The care plan documented that the resident had a self-care deficit related to dementia, lack of coordination, and hemiplegia, and also noted a history of refusing care, including foot care and podiatry services. However, there was no documentation in the nursing progress notes of refusals or attempts to trim the toenails after the last podiatry visit, which occurred several months prior to the observation. Staff interviews revealed that while the resident sometimes refused care, the expectation was that refusals should be documented and reported to the physician and responsible party. The facility's policies required daily grooming activities, including nail care, and documentation of care provided or refusals. Despite these requirements, the clinical record did not show evidence of toenail care or documentation of refusals after the last podiatry visit, indicating a lapse in following facility policy and in providing necessary foot care for the resident.