Failure to Provide and Document Necessary Toenail Care
Penalty
Summary
The facility failed to provide appropriate toenail care for one resident when surveyors observed the resident’s toenails to be thick, overgrown, and approximately half an inch long. The resident, who had intact cognition with a BIMS score of 13, had been admitted with diagnoses including diabetes mellitus and required partial to moderate assistance with most ADLs. A significant change assessment documented these needs, yet nurse’s notes from late August through January contained no indication that the resident’s toenails required cutting or that a podiatry referral was needed. The resident reported that their toenails had needed cutting since admission and that they had informed staff on multiple occasions. The facility had no policy related to nail care, and although the DON stated that LPNs were expected to assess toenails weekly as part of skin assessments and that nursing and social services were responsible for signing residents up for podiatry services, there was no documentation that this occurred for this resident. The podiatrist reported that services were last provided in the facility several months earlier, and the ADON stated staff had attempted to cut the resident’s toenails but this was not documented. These combined observations and record reviews showed that the facility did not ensure toenail care was provided or documented for this resident in accordance with their needs and stated practices.
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