Failure to Provide Required Nail and Podiatry Care for Diabetic Resident
Penalty
Summary
The facility failed to provide necessary assistance with nail care for a resident who required help with activities of daily living. The resident had moderate cognitive impairment, schizophrenia, diabetes mellitus type 2, and COPD, and used a wheelchair and walker for mobility. The MDS indicated the resident required partial to moderate staff assistance for showering and setup assistance for eating and oral hygiene, and the care plan stated the resident was independent with ADLs but should be assisted as needed. During observation, the resident was seen at the nurse’s station with long, jagged fingernails and a brown-like substance under some nails. In an interview, the resident reported that staff did not trim his fingernails, stated they needed to be done, and further reported that his toenails were worse. When the resident removed his socks, his toenails were observed to be long and jagged. The resident stated nursing staff did not cut or trim his toenails and denied that a podiatrist or other physician had trimmed them. The clinical record contained a physician order for an annual podiatry visit for diabetic foot care, but there was no documentation that podiatry care had been provided. An RN stated that nursing staff trimmed and filed residents’ nails and that diabetic residents were usually referred to a podiatrist for toenail care, and reported having trimmed the resident’s fingernails in the past but never his toenails, with no known refusals. A CNA, who provided the resident’s showers and bed baths, stated she would normally notify nurses and mark the shower sheet if nail care was needed and thought she had indicated this for the resident but may not have due to being busy. The DON reviewed the shower sheet and confirmed it documented that the resident did not need nail care and that the resident, a diabetic, had not been scheduled with the facility’s podiatrist, despite facility policy requiring diabetic residents to see a podiatrist at least annually for toenail and/or foot care.
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