Failure to Provide Foot Care and Podiatry Services
Penalty
Summary
The facility failed to provide foot care consistent with professional standards of practice for eight residents reviewed. Multiple residents were observed to have very long, thick, and discolored toenails, with some residents reporting pain and discomfort. Interviews with residents and their family members revealed that they had not seen a podiatrist, and photographic evidence was obtained to document the condition of their toenails. Review of medical records and physician's orders for these residents showed no current, past, or discontinued orders for podiatry care, visits, or referrals, except for one resident who had a single podiatry note with no ongoing documentation of foot or toenail care. Staff interviews indicated a lack of familiarity with the facility's nail care policy and procedure. The unit manager stated that while feet are assessed for skin issues, toenail conditions are not documented, and residents with long or damaged toenails are placed on a list for podiatrist visits, which are coordinated by social services. Certified Nursing Assistants reported that they do not cut residents' nails and would report long nails to a nurse. The Social Services Director explained that previous podiatry services required cash payment and that a new contract with a podiatrist had recently been established, but services had not yet started. The appointment book for podiatry visits could not be located when requested. The Director of Nursing confirmed that a new podiatrist had been contracted but was unaware of a start date and was not familiar with the nail care procedure. Overall, the facility did not ensure that residents received necessary foot care or assistance in making appointments with qualified healthcare providers, resulting in multiple residents experiencing prolonged periods without appropriate podiatry care.