Failure to Provide Proper Foot Care and Assessment
Penalty
Summary
A deficiency occurred when a licensed vocational nurse (LVN) responsible for weekly skin assessments failed to assess a resident's feet, resulting in significantly long toenails and two ingrown toenails going unnoticed. The resident, who had a diagnosis of Critical Illness Myopathy and was at risk for skin breakdown due to impaired mobility, reported foot pain related to ingrown toenails and stated he had informed nursing staff about the issue since admission. Despite weekly skin assessments being part of the care plan, the LVN did not recall assessing the resident's feet, and the charge nurse was unaware of any foot problems. Upon assessment by the Director of Nursing (DON), the resident was found to have scaly, dry feet, all toenails were long, and both great toenails appeared ingrown, with one toenail extending approximately one inch past the nail bed and showing red spots. The DON confirmed that the treatment nurse should have identified these issues during routine assessments, and that certified nursing assistants (CNAs) should also report any skin problems. Facility policy required comprehensive physical exams, including skin and foot assessments, but these were not properly completed for this resident.