Failure to Provide Regular Toenail Care for Two Residents
Penalty
Summary
The facility failed to provide appropriate foot care for two residents, resulting in untrimmed, thick, and abnormally curved toenails. Observations revealed that both residents had toenails approximately one inch long, yellowish, thick, and in some cases, digging into the skin. One resident reported pain and an inability to wear shoes due to the condition of her toenails. Both residents were noted to have severe cognitive impairment and required assistance with personal care, including dressing and footwear. Record reviews indicated that both residents had care plans identifying self-care deficits and interventions for nail care, such as checking and trimming nails during bathing. However, interviews with staff, including CNAs, the DON, and the social worker, revealed a lack of clarity and follow-through regarding responsibility for toenail care. Staff stated that a podiatrist visited the facility every 62 to 90 days and that non-diabetic residents should receive toenail care from facility staff during showers. Despite these policies, staff were unaware of why the residents' toenails had not been trimmed or referred to the podiatrist. The facility's ADL Nail Care Policy required regular and safe nail management to promote cleanliness and prevent infection or injury. Despite this policy, both residents were observed with abnormal nail conditions, and staff interviews confirmed that expected nail care was not provided. The lack of toenail care was not explained by staff, and the residents remained with untreated, overgrown toenails at the time of the survey.