Failure to Provide Foot Care and Arrange Podiatry for Diabetic Resident
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate foot care and arrange podiatry services for a resident with dementia, Parkinson’s disease, and diabetes mellitus. On admission, the nursing assessment did not note any toenail issues, and the admission MDS documented moderately impaired cognition, need for assistance with mobility, toileting, transfers, bathing, and dressing, as well as diagnoses of Parkinson’s disease, dementia, DM, and arthritis, and risk for pressure ulcer development. The resident’s care plan, developed by the RD, addressed only potential nutritional problems and did not include any other care areas. Weekly nursing assessments over several months contained no notation that the resident’s toenails were long, thick, or needed trimming. Review of the podiatry clinic schedule and EMR showed the resident was not scheduled for, nor seen by, a podiatrist since admission. During observations, surveyors noted the resident had thick, long, jagged toenails on both feet, with a brownish discoloration at the base of the left great toenail extending toward the middle of the nail. The resident stated her toenails looked “nasty,” that she could not bend down to care for her feet, and that her daughter had trimmed her toenails before admission. The wound nurse acknowledged she did not notice the resident’s toenails and had not requested that she be added to the podiatry list. The ADON stated the resident should be seen by a podiatrist because she was diabetic and confirmed that, although responsible for adding residents to the podiatry schedule in the absence of a Social Worker, she had not referred this resident since admission. A NA who frequently provided showers reported noticing that the resident’s toenails were very long and needed trimming but could not recall if she reported this to a nurse. The resident’s family member confirmed the resident had been unable to care for her feet for a long time and that she previously kept the toenails trimmed due to the resident’s diabetes.
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