§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 clinical record review, observation, and staff interview, it was determined that the facility failed to provide nail care to maintain good foot health for four of six sampled residents. (Residents 3, 4, 5, 6)
Findings include:
Clinical record review revealed that Resident 3 was admitted to the facility on November 11, 2021, and had diagnoses that included senile degeneration of the brain, need for assistance with personal care, and history of deep vein thrombosis (a condition in which blood clots form in veins deep within the body, usually in the legs). The Minimum Data Set (MDS) assessment dated March 8, 2022, indicated that the resident was cognitively impaired and required extensive staff assistance for care. Observation on April 5, 2022, with LPN 1, revealed that the resident had long toenails that were curled in proximity to adjacent toes and requiring nail care.
Clinical record review revealed that Resident 4 was admitted to the facility on December 25, 2021, and had diagnoses that included dementia and need for assistance with personal care. The MDS assessment dated March 29, 2022, indicated that the resident was cognitively impaired and required extensive staff assistance for care. Review of the resident's care plan revealed that due to reddened heels, an intervention included care from the podiatrist, as needed. Observation on April 5, 2022, with LPN 1, revealed that the resident's toenails were long and in need of nail care.
Clinical record review revealed that Resident 5 was admitted to the facility on December 1, 2021, and had diagnoses that included multiple sclerosis (a disease that affects the central nervous system) and cognitive communication deficit. The MDS assessment dated March 8, 2022, indicated that the resident was cognitively impaired and required extensive staff assistance for care. Observation on April 5, 2022, with LPN 1, revealed that the resident's toenails were long and in need of nail care. At the time of observation, the resident stated that her nails were long and that she needed to see a podiatrist.
Clinical record review revealed that Resident 6 was admitted to the facility on December 17, 2021, and had diagnoses that included hemiplegia and hemiparesis (one-sided weakness/paralysis) affecting the dominant side and cognitive communication deficit. The MDS assessment dated December 24, 2021, indicated that the resident required extensive staff assistance for care. Observation on April 5, 2022, with LPN 1, revealed that the resident's toenails were long and in need of nail care.
During an interview on April 5, 2022, LPN 1 confirmed that the identified residents were in need of foot (nail) care.
During an interview on April 5, 2022, the Administrator reported that Residents 3, 4, 5, and 6 had not been seen by a podiatrist since admission to the facility.
28 Pa. Code 211.12(d)(1)(3)(5) Nursing services.
| | Plan of Correction - To be completed: 05/25/2022
1. Resident 3, 4, 5, & 6 will have podiatry orders written and be seen by podiatry to have their toe nails cut and trimmed as needed.
2. All residents in house will be assessed for foot care needs and podiatry orders written as needed
3. All new admissions will be assessed for foot care needs and podiatry consulted as needed
4. Education provided to all nursing staff re: F687
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