Failure to Provide Proper Foot Care and Podiatry Services
Penalty
Summary
The facility failed to provide appropriate foot care to five residents, as evidenced by observations, interviews, and record reviews. Residents with moderate cognitive impairment and various diagnoses, including diabetes, peripheral vascular disease, and schizophrenia, were found to have unaddressed foot care needs. Despite facility policies requiring assessment, routine care, and referral to a podiatrist for residents with complicating conditions, there was no documentation of podiatry visits or consults for these residents, even when physician orders allowed for podiatrist visits. Direct observations revealed that several residents had excessively long, thick, jagged, and curled toenails, as well as extremely dry feet with large flakes of skin. Some residents wore socks with holes or soiled socks, and in one case, a resident reported discomfort due to a long toenail rubbing against footwear. Interviews with residents confirmed that they had not received podiatry services or adequate foot care, and some expressed a desire for their feet to be moisturized or toenails to be trimmed by a professional. Staff interviews indicated that while there were expectations for nurses and aides to assess, moisturize, and refer residents for podiatry care, these actions were inconsistently carried out. Staff acknowledged that refusals of care should be documented, but there was no evidence of such documentation or follow-up in the medical records. The lack of documented podiatry visits, inadequate routine foot care, and failure to address residents' expressed needs and physician orders led to the deficiency.