F0687

E

Failure to Provide Timely Podiatry Foot Care for Diabetic Residents

San Antonio, Texas Survey Completed on 03-27-2026

Penalty

No penalty information released

Summary

The deficiency involves the facility’s failure to provide podiatry foot care and treatment in accordance with professional standards of practice for three residents with diabetes who were care planned to receive podiatry services. All three residents had care plans indicating diabetes mellitus with an intervention to refer to a podiatrist or foot care nurse to monitor and document foot care needs and to cut long nails. A local podiatry group was scheduled to provide services on 3/4/26, and all three residents were listed to be seen, but they did not receive foot care during that visit. Record review showed that the last podiatry service date for each of these residents was 10/28/2025, despite their insurance allowing 4–6 podiatry visits per year.

Resident #1 was an 82-year-old female with unspecified dementia, type 2 diabetes mellitus, and a need for assistance with personal care, who was dependent on staff for putting on and taking off footwear and had no cognitive impairment per a BIMS score of 15. During observation and interview, she reported needing help cutting her toenails, stated she could not do it herself, and that nurses did not cut her nails because she had diabetes and the podiatrist had to do it. She reported her last toenail trimming was about five months prior. Her toenails were observed to extend up to 1/4 inch beyond the flesh of the toes, with some nails curving toward the skin.

Resident #2 was a male with spinal stenosis with neurogenic claudication, type 2 diabetes mellitus, and a need for assistance with personal care, who required substantial to maximum assistance with footwear and had a BIMS score of 15. He stated that a podiatrist usually cut his toenails but that he had not seen her in quite a while. Resident #3 was a female with unspecified dementia, type 2 diabetes mellitus, a need for assistance with personal care, and moderate cognitive impairment with a BIMS score of 7, who ambulated with a walker. She reported asking staff about getting her toenails cut and being told it would occur when the podiatrist came, stated her toenails were last cut the previous year, and reported pain with wearing shoes and embarrassment. Her toenails were observed to be 1/2 to 1 inch beyond the flesh of the toe. A family member reported that a hospital had noted her need for nail care and that the podiatrist had left before seeing her at the last visit. The SW confirmed the podiatry company could not see everyone on the March visit, could not return until late April, and that only the podiatrist provided toenail care for residents with diabetes, consistent with the facility’s nail care policy stating that nail care, especially trimming, is performed by a podiatrist in those with diabetes and peripheral vascular disease. The DON and ADON acknowledged that some residents did not receive foot care and that this put them at risk for injury or infections, and that long toenails can be a fall hazard and cause pain.