F0687

D

Failure to Ensure Ongoing Podiatry Care and Follow-Up for Foot and Nail Abnormalities

Hamden, Connecticut Survey Completed on 03-09-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide ongoing podiatry care and timely follow-up for a resident with documented foot and nail abnormalities. The resident had diagnoses including mild cognitive impairment, dysthymic disorder, left foot drop, moderate protein calorie malnutrition, PVD, neuropathy, onychomycosis, and dermatophytosis. A podiatry note documented on 9/22/25 described thick, yellow, brittle toenails with subungual debris and indicated that aseptic debridement of all ten toenails was performed, with a plan for follow-up in six to eight weeks. However, the resident’s care plan from 9/22/25 through 2/9/26 did not include podiatry abnormalities, nail disorders, infections, or foot and nail diagnoses to guide ongoing treatment and monitoring.

From 9/22/25 to 2/9/26, the clinical record contained no further podiatry treatment notes or documentation of refusals of podiatry care for this resident. Nurse’s notes during this period did not address the condition of the resident’s feet or toenails or any refusals of podiatry services, and the TARs for September 2025 through February 2026 did not show any treatments or monitoring related to the resident’s feet or toenails. Podiatry Service Lists dated 11/10/25, 12/22/25, and 1/6/26 showed the resident was due for follow-up for tinea unguium, but each visit was rescheduled without a documented reason, and the resident was not seen. A Podiatry Service List dated 2/3/25 indicated the resident was due for follow-up and refused the visit, but there was no corresponding nursing documentation of this refusal in the nurse’s notes from 2/3/26 through 2/9/26.

The resident’s conservator later reported being shocked by the condition of the resident’s toenails, describing them as so thick and long that they were curling, and stated that the facility had not notified them of podiatry issues or refusals of care. The Administrator acknowledged being unaware of the 9/22/25 podiatry note and was unsure how nursing staff became aware of podiatry recommendations, noting that podiatry notes were sent to Medical Records and communication with the podiatry group occurred by email. The DON stated that nursing staff should have followed up on the 9/22/25 podiatry visit for orders and recommendations, assessed and documented the toenail condition, and notified leadership to facilitate timely follow-up, but there was no designated nurse responsible for coordinating podiatry visits and no process to ensure specialty providers’ findings were communicated to nursing before leaving the facility. The DON also reported misinterpreting several Podiatry Service Lists as refusals and could not determine why the resident was not seen on those dates. The APRN reported she was never notified of the podiatry findings or the reported refusal and stated that nursing should have documented and notified her of the podiatry visit and ongoing issues so that monitoring and timely follow-up could have occurred.