Failure to Assess and Arrange Podiatry Care for Long, Painful Toenails
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate foot care and arrange podiatry services for a resident with multiple medical conditions, including CAD, hypertension, diabetes mellitus, and a history of CVA. The resident’s care plan, revised on 12/07/25, identified the need for extensive and total staff assistance with ADLs, including grooming and personal hygiene, while also noting that the resident ambulated independently with a cane. A quarterly MDS documented that the resident had moderately impaired cognition but was independent with dressing, footwear, personal hygiene, and ambulation with a walker, and did not reject care. Despite these assessments, the resident’s weekly skin assessment dated 02/05/26, completed by Nurse #1, contained no notation that the toenails were long, thick, or required trimming or podiatry referral, even though Nurse #1 later acknowledged she had noticed the long toenails at that time but did not document them because the resident had not complained. Further record review showed the resident was not on the February 2026 podiatry clinic schedule, and there were no podiatry consultation reports or notes from admission through 02/11/26. During an observation and interview on 02/08/26, the resident removed his socks and displayed thick, long toenails on the left foot extending past the nail bed, reporting pain when putting on shoes and walking, and stating he had not reported this because he did not want to bother staff, although he believed staff had seen them. Subsequent observations with Nurse #1 and the Wound Care Nurse confirmed the toenails were long, thick, and in need of podiatry trimming, with the left hallux nail curved to the side and measured lengths up to 3 cm. Nursing assistants reported they had not seen the resident’s toenails because he dressed himself, wore his socks, and preferred to bathe in his room with only set-up assistance, and he had not voiced discomfort to them. The DON stated that NAs should have alerted nurses and that nurses should have assessed toenails during weekly skin assessments and placed the resident on the podiatry list when needed, while the Administrator reported she had not been informed of the issue and that the resident had not approached her with concerns.
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