Failure to Obtain Podiatry Care and Provide Foot Care for Diabetic Resident
Penalty
Summary
Facility staff failed to provide necessary podiatry consultation, treatment, and foot care for a diabetic resident over a three‑month period following admission. The resident was admitted with Type 2 Diabetes Mellitus, hyperlipidemia, cerebral infarction, and schizophrenia, and had physician orders for PRN podiatry consults as well as weekly skin assessments and heel offloading. Multiple skin and wound notes dated over several weeks (10/14, 10/21, 10/28, 11/07, and 11/14) repeatedly documented recommendations for routine in‑house podiatry evaluation for nail trimming and management of thickened nails. The resident’s care plan directed staff to inspect feet daily, refer to podiatry or a foot care nurse for monitoring and nail cutting, and to check nail length and trim and clean nails on bath days and as necessary. Despite these orders and care plan interventions, the resident was not seen by a podiatrist during the three months since admission, even though a podiatrist was documented as being in the facility on multiple occasions. Quarterly MDS data showed the resident had intact cognition and required supervision or touching assistance for bathing, lower body dressing, and footwear, indicating dependence on staff for foot care. Weekly skin assessments by licensed nurses in late December and early January documented no skin impairment and continuation of the plan of care, without addressing the ongoing need for podiatry services or the condition of the resident’s toenails. On observation, the surveyor noted that the resident’s toenails on both feet were overgrown, thickened, yellow, and in several toes curved downward and digging into the skin on the bottoms of the feet. The assigned CNA and LPN confirmed these findings when called to the room, and the LPN stated she had noticed that the toenails were long and that the resident needed to see podiatry. The DON and unit manager also observed the condition of the resident’s feet and confirmed that the resident had not been seen by a podiatrist since admission, although he was on the list to be seen. The administrator later stated that the resident’s Medicaid application was pending and that he did not yet have insurance coverage for podiatry, but acknowledged that exceptions could be made and the facility could cover the cost, which had not occurred during the three‑month period in question.
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