Failure to Provide Timely and Appropriate Foot Care
Penalty
Summary
The facility failed to provide appropriate foot care and treatment in accordance with professional standards of practice for two of four sampled residents. Both residents were observed to have long, overgrown, and untrimmed toenails, with one resident's toenails described as yellow, thick, jagged, and with a dark crusted substance under the big toenail. Certified Nursing Assistants (CNAs) and Licensed Vocational Nurses (LVNs) acknowledged that the residents' toenails needed trimming and confirmed that the process for reporting and addressing nail care needs was not followed as required. Record reviews revealed that both residents had been identified on multiple occasions as needing toenail care, as documented on their shower sheets. However, the necessary follow-up actions, such as logging the residents for podiatry appointments or ensuring nail care was performed by nursing staff, were not completed. The Social Services Director's log, which should have included these residents for podiatry referral, had not been updated to include them, and the last entry was several months prior. Staff interviews confirmed that the expected process for addressing nail care needs was not adhered to, and there was no documentation of refusals or completed care for these residents during the relevant period. Both residents had significant medical histories, including severe cognitive impairment, traumatic brain injury, and physical disabilities for one, and schizophrenia, pain, and muscle weakness for the other. Observations and interviews with staff and review of facility policies confirmed that the facility's procedures for nail care, including daily cleaning, regular trimming, and prompt reporting of issues, were not followed. The deficiency was further substantiated by photographic evidence and staff admissions that the residents' nail care needs had not been addressed as required.