§483.25(b)(2) Foot care.
To ensure that residents receive proper treatment and care to maintain mobility and good foot health, the facility must:
(i) Provide foot care and treatment, in accordance with professional standards of practice, including to prevent complications from the resident's medical condition(s) and
(ii) If necessary, assist the resident in making appointments with a qualified person, and arranging for transportation to and from such appointments.
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Observations:
Based on review of clinical records, observations, and resident and staff interviews, it was determined that the facility failed to consistently provide timely and necessary foot care for one of 19 residents reviewed (Resident R1).
Findings include:
Resident R1 was admitted to the facility on 5/8/26, with diagnoses that included Cellulitis (a skin infection caused by bacteria, most commonly affecting the lower leg. Symptoms include swelling, pain, warmth, and redness), Chronic Obstructive Pulmonary Disease (COPD a condition that prevents airflow to the lungs resulting in difficulty breathing), and Gastroesophageal reflux disease (GERD - happens when stomach acid flows back up into the esophagus and causes heartburn).
Resident R1's physician's orders revealed an order dated 5/8/26, for "Podiatry (branch of medical care focused on assessment, diagnosis, and treatment of conditions affecting the feet, ankles and lower extremities) Consult and Treat as needed" and a consent for 360 Care - podiatry signed and dated by Resident R1 on 5/11/26.
Resident R1's clinical record progress note dated 5/8/26, at 18:01 revealed "Toenails are long, mycotic (fungal infections of the toenails that cause thickening, discoloration [yellow, brown, or white] brittle, crumbly or ragged edges, and separation or lifting of the nail from the nail bed. Possible pain or discomfort can result in severe cases), and in need of trim." Further review revealed progress notes entitled "Skin and Wound" dated 5/19/26, 5/27/26, 6/3/26, 6/10/26, 6/17/26, 6/24/26, 7/1/26, and 7/8/26, indicating "Consultations (Recommendations) Podiatry toenail care."
Observation on 7/7/26, at 11:50 a.m. revealed Resident R1's toenails, on both feet, were thickened, yellowed, and extended past the tips of his/her toes, and the surface of the nails appeared rough and uneven.
During an interview on 7/7/26, at the time of observation Resident R1 stated that he/she was unsure the last time he/she saw a podiatrist but knows it was before coming to the facility. Resident R1 then stated that he/she is receiving physical therapy so that he/she can walk and be able to go home, but that the condition of his/her toenails makes it painful and difficult to walk.
Review of facility provided document entitled "360 Care Appointment Listing Podiatry" dated 7/1/26, lacked evidence of Resident R1 being scheduled to see the podiatrist for nail care.
During an interview on 7/8/26, at 2:39 p.m. Nursing Home Administrator (NHA) revealed that if a resident signs consent for 360 Care, it is faxed to 360 Care, and the resident is put on their list to be seen during their next visit.
During an interview on 7/9/26, at 10:30 a.m. NHA revealed 360 Care podiatry provided services on 5/18/26, and 7/1/26, and that Resident R1 was missed on both of those visits, and he/she should have been seen and toenail care provided.
28 Pa. Code 211.12 (d)(3)(5) Nursing Services
| | Plan of Correction - To be completed: 07/24/2026
1. Resident R1 podiatry appointment is scheduled for 7/18/26.
2. A whole house audit of toenails was completed 7/9/26, all residents noted of need for clippings was compiled, on staff LPN to complete all clippings by 7/16/26 and anyone needing to see podiatrist will be seen on 07/27/26.
3. A new policy for all 360 services was implemented 7/9/26. Nursing department education will be completed on said policy on 7/16/26 to prevent any further reoccurrence.
4.Audits of resident's toenails and services to ensure services are ordered and completed will be completed once a month, if found to need services will be added to the list for specialty care or if sooner action is required be sent out for a scheduled appointment. Audits will be done by Director of Nursing or designees. This will be done for all new admissions and 5 random per hall. This will be taken to the Quality Assurance meeting for review.
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