Failure to Provide Adequate Daily Foot Care and Hygiene
Penalty
Summary
The deficiency involves the facility’s failure to provide adequate foot care and skin hygiene for a dependent resident with multiple comorbidities, including Type 2 hemiplegia/hemiparesis, epilepsy, and Parkinson’s disease. The resident’s MDS showed severely impaired cognition and dependence on staff for footwear, lower body dressing, bathing, and substantial/maximal assistance for personal hygiene. Physician orders included daily and weekly skin checks, daily betadine application to the right foot, and moisturizing lotion to both lower extremities as needed for dry skin. A podiatry note documented dry, thin skin on both feet and directed that the feet be kept clean with daily lotion use. Despite these orders and the resident’s dependence, staff reported no skin concerns prior to the surveyor’s observation. On observation, when the nurse removed the resident’s pressure-relieving boots and socks, a brownish-orange waxy crust was seen covering most of the bottoms of both feet, with additional crust on the sides, tops, ankles, and shins, and a large amount between all toes. As the nurse wiped the feet with a wet towel, chips of the substance fell off, revealing intact, pink, dry skin underneath, and only a small portion of the buildup was removed at that time. The DON stated the buildup was not typical and that the feet appeared very dry, and acknowledged the feet should not have had that extent of waxy buildup. The wound nurse stated she had applied cream earlier that morning, acknowledged the substance had been present for a long time, and indicated staff were expected to wash the resident’s feet during scheduled bed baths and apply cream/ointment daily. A CNA reported she had not washed the resident’s feet or applied lotion during morning care, and another CNA stated the brown-orange crust appeared intermittently. The nurse practitioner later described approximately 50% of the bottoms of both feet as covered with easily removable waxy, yellow/orange-brown dry skin and stated the condition was preventable with daily cleaning and moisturizing, noting that staff were expected to perform daily foot care to remove such buildup.
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