Failure to Provide Ordered Podiatry Care and Foot Assessment
Penalty
Summary
The deficiency involves the facility’s failure to provide appropriate foot care and podiatry services in accordance with professional standards and its own policy for a resident who required assistance with personal hygiene. The resident was admitted with paranoid schizophrenia and generalized anxiety and had a quarterly MDS showing a BIMS score of 13/15, indicating no cognitive impairment, but a need for substantial to maximum assistance with personal hygiene. The resident had a physician’s order for podiatry care, and a local podiatry group was providing services to multiple residents in the facility; however, the resident’s name did not appear on the podiatry schedule. On observation, the resident’s toenails were approximately 1/2 inch past the nailbeds, with very thick great toenails, and the resident reported needing them cut, stating that a CNA had tried to clip them but they were too thick and that he preferred podiatry to do it. He also stated he had not seen a podiatrist since admission. The charge nurse (LVN) acknowledged during observation that the resident’s toenails were long and needed cutting and that the great toenails were very thick, but she stated she had not noticed the length of his toenails before that day and that there was nothing in the progress notes indicating a need for podiatry referral. The DON stated that staff would not document the condition of long toenails on weekly skin sheets and that she did not necessarily require staff to document the need for podiatry care in a progress note, instead expecting staff to verbally inform the social worker so a referral could be made. The social worker reported that any staff could notify her of the need for podiatry care and that review of the last podiatry list showed the resident had not been seen. The facility’s undated “Podiatry Services” policy stated that residents requiring foot care with complicating conditions would be referred to qualified professionals and that employees should refer identified foot care needs to the social worker, who would assist with appointments and transportation. Despite these orders and policies, there was no documented or acted-upon referral for this resident’s podiatry care, resulting in prolonged overgrown and thick toenails.
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