Failure to Provide Timely Foot Care and Podiatry Services
Penalty
Summary
The facility failed to ensure appropriate foot care for three residents, resulting in untrimmed, thick, and curling toenails, and a lack of timely podiatry services. For each of the three residents, weekly nursing assessments did not document the need for toenail care, and there was no evidence in the electronic medical records that referrals to podiatry had been made or that the residents had been seen by a podiatrist. Observations revealed that all three residents had long, thick toenails, with some nails curling inward or appearing blackened, and staff interviews confirmed that these issues had not been reported or addressed. One resident with a traumatic brain injury and contractures was completely dependent on staff for all activities of daily living and was severely cognitively impaired. Despite this, her toenails were observed to be thick, long, and in poor condition, with no record of podiatry referral or care since admission. Another resident with a left above-the-knee amputation and peripheral vascular disease was also dependent on staff for personal care. His toenails were found to be thick and curling, and although staff recognized the need for podiatry intervention, no referral had been made, and he had not been scheduled for podiatry clinic visits. A third resident with peripheral artery disease and a below-the-knee amputation was similarly dependent on staff and unable to care for her own toenails. Her toenails were observed to be long and curling, and although she had previously refused podiatry care, there was no documentation of follow-up or rescheduling for podiatry services. Interviews with nursing staff, the nurse practitioner, the DON, and the social worker revealed a lack of communication and follow-up regarding residents' toenail care needs. Staff members often could not recall if they had reported the need for podiatry services, and the process for adding residents to the podiatry list was inconsistently followed. The DON and social worker acknowledged that sometimes follow-up did not occur as it should, resulting in residents not receiving necessary foot care.