Failure to Provide Timely Foot Care and Podiatry Referral for Diabetic Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate foot care and timely podiatry referral for a resident with diabetes and multiple comorbidities. The resident was admitted with diagnoses including cerebral infarction, hypertensive heart disease, and enterocolitis due to C. difficile, and had a care plan identifying diabetes with a goal to reduce complications, including weekly skin checks and referral to a podiatrist as needed. A physician order dated 12/25/25 authorized evaluation and treatment for mycotic nail care, and a skin assessment on 1/6/26 documented a foot evaluation but did not include any information about the condition of the resident’s toenails. On observation, the resident was noted to have long fingernails and reported that both her fingernails and toenails were long and needed cutting, describing them as “like claws.” During an interview, an LVN initially stated the resident was not diabetic and that CNAs could provide nail and foot care on shower days, but upon reviewing the electronic health record, he acknowledged the resident had Type 2 diabetes and was receiving daily insulin. He also stated that nursing staff should provide nail care and reported that he had rounded on the resident twice on the date of observation without noticing or being informed about the long nails. Later observation and assessment with the same LVN confirmed that the resident’s toenails were long and needed cutting, and the LVN identified discoloration of the right great toenail, stating that if it was fungus, a podiatrist would need to assess it and that a podiatry referral would be required. The DON stated that the resident was known to sometimes refuse care and that refusals should be documented in progress notes, but there was no documentation on the weekly skin assessment reflecting long toenails or discoloration. The DON further stated that foot assessments should be captured on weekly skin assessments and that nursing staff should refer the resident to podiatry as needed, acknowledging that, to her knowledge, the resident had not been referred to podiatry until after the LVN’s assessment on 1/6/26, despite the existing policy on managing special needs such as podiatry and the physician order for mycotic nail care.
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