Failure to Provide Podiatry Services and Foot Care for Diabetic Resident
Penalty
Summary
The facility failed to provide appropriate foot care and podiatry services to a resident with type 2 diabetes, neuropathy, circulatory complications, and hemiplegia/hemiparesis following a subarachnoid hemorrhage. The resident had moderately impaired cognition and required substantial to maximum assistance with activities of daily living. Review of the care plan, quarterly MDS, nurse progress notes, shower book, and weekly skin assessments from December through early February showed no documentation that the resident’s long toenails were identified, addressed, or that a podiatry appointment was arranged. The skin assessment sections attached to shower sheets were not checked to indicate a need for nail trimming, and the resident’s name did not appear on podiatry lists for the prior six months. On observation, the resident called out for help and reported toe pain; her great toenails and remaining toenails were noted to be long, thick, and jagged, and she was not wearing socks. Nurse aides reported that they could not cut the resident’s toenails and that their role was to inform the nurse when toenails needed cutting, especially for residents with diabetes who must be seen by a podiatrist. One nurse aide acknowledged she had not informed the nurse that this resident’s toenails needed cutting, and the charge nurse stated she had not cut the resident’s toenails and had not been asked to do so. The social worker reported the resident had not been identified as needing podiatry, and the DON stated that residents with diabetes should have their nails cut by podiatry and that nurses should assess feet and either cut nails or place residents on the podiatry list. The administrator stated he was unaware the resident needed podiatry and that nurses were responsible for ensuring the social worker received a current list of residents needing podiatry services.
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