Failure to Coordinate Podiatry and Dermatology Consults for Two Residents
Penalty
Summary
The deficiency involves the facility’s failure to ensure outside professional resources were obtained and coordinated for required services, specifically podiatry for one resident and dermatology for another. One resident reported to nursing staff that her toenails were very long, that she could not cut them herself, and that they were uncomfortable. A nursing progress note documented on 2/16/2026 that this resident’s nails were very long and that she needed a referral to a podiatrist. However, there was no further follow-up in the medical record regarding a podiatry referral, and the resident’s name did not appear on the podiatry visit list for the provider’s 2/18/2026 visit. Another resident, who was cognitively intact and had diagnoses including morbid obesity, Type 2 diabetes, and unspecified kidney failure, was observed in bed scratching and itching her arms and upper body, with scaly, dry, rough skin and small fishlike flakes. The resident stated she was supposed to see a dermatologist, that her family had discussed this with the facility the previous Friday, and that she was only using regular store lotion, which was not helping, while her itching was getting worse. Physician orders included a dermatology consultation for body itching, a follow-up with dermatology, and an order for ammonium lactate lotion to be applied twice daily for dry skin. Review of the MAR and TAR showed the resident was not receiving any treatment for the ongoing itching condition during the reviewed period. The facility’s own consult policy stated that Social Services would coordinate most resident referrals (such as podiatry and vision), that referrals should be based on physician evaluation and orders, and that Social Services would document referrals and maintain a listing of referral agencies. In practice, the Social Services Director reported that nursing staff were expected to notify her of residents needing podiatry so they could be added to the list, but there was no evidence this occurred for the resident with long nails. For the resident with dermatologic issues, the Social Services Director stated dermatology appointments were scheduled by nursing and that she had not been informed of any concerns, family complaints, or need for dermatology, and no grievance had been initiated. Nursing staff and the ADON were not aware of or did not verify dermatology orders or visits, and record review showed no documented dermatology visits or physician notes beyond a single prior encounter, indicating a lack of coordination and follow-through with outside dermatology services despite existing orders and ongoing symptoms.
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