Failure to Notify Physician and POA of Repeated Refusals of Antifungal Foot Treatment
Penalty
Summary
The deficiency involves the facility’s failure to notify a resident’s physician and power of attorney (POA) of repeated refusals of prescribed antifungal treatment for tinea pedis. The resident had diagnoses including diabetes mellitus and rheumatoid arthritis, was documented as alert and oriented in a history and physical, and had moderate cognitive impairment and an infection on both feet per the MDS. A physician’s order dated 11/6/2025 directed that Ciclopirox cream be applied to both feet once daily for tinea pedis. Progress notes documented that the resident refused treatment to both feet on 1/8/2026, 1/10/2026, 1/11/2026, and 1/12/2026, and the Treatment Administration Record showed refusals of the fungal treatment on 1/10/2026, 1/11/2026, and 1/12/2026. Despite these repeated refusals, the physician and the resident’s POA were not notified. During an interview, the treatment nurse stated he should have notified the physician and POA after the resident’s third refusal of the fungal treatment. In a concurrent interview and record review, the DON stated the treatment nurse should have completed a change of condition (COC) when the resident refused the foot fungal treatment for the third time so that the physician could be informed and a new plan of care considered, and that the POA should have been notified so they could talk to the resident about refusing care. The facility’s Change of Condition policy indicated that when a resident’s condition or care needs change, the nurse should use clinical judgment to contact the physician and notify the resident or resident representative of the change in condition and any changes in medical or nursing care. The failure to follow this process resulted in the resident not receiving the ordered treatment for four days and, as stated in the report, had the potential to cause infection, inflammation, and hospitalization.
We Help Long-Term Care Teams Stay Survey-Ready
We process and analyze inspection reports and plan of correction using AI to extract insights and trends so providers can improve care quality and stay ahead of compliance risks.